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Oh Juvenile Justice Detention Report by Fred Cohen 2007

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January 2008

S.H. v. Stickrath

EXECUTIVE SUMMARY .............................................................................................................................i

FRAMEWORK: LEGAL & OPERATIONAL..............................................................................1


CONCEPTUAL FRAMEWORK & OVERVIEW ........................................................................5
A Damaged Population.......................................................................................................5
Constitutional Standard on Safe Environment ................................................................8
Incidence of Mental Disorder.............................................................................................9
Competing Models ..............................................................................................................10
Education: Holistic Approach............................................................................................10
Medical Issues .....................................................................................................................14
Ohio Law: Confused and Regressive ................................................................................16


SAFE ENVIRONMENT: FORCE, ISOLATION, & RESTRAINT.............................................23
Safe Environment ...............................................................................................................23
Restraints and Isolation......................................................................................................28
Incident Reports..................................................................................................................33
Select Use of Force Incidents..............................................................................................41


Scioto Juvenile Correctional Facility Report: [Dr. Kathryn A. Burns] .........................48
Mental Health Services for Boys: Reception Screening & Assessment....................48
Mental Health Staffing .................................................................................................49
Girls’ Residential Mental Health Unit ........................................................................51
Mental Health Treatment.............................................................................................52
Marion Juvenile Correctional Facility Report: [Dr. Kathryn A. Burns].......................55
Mental Health Staffing ................................................................................................55
Intensive Mental Health Unit......................................................................................57
Mental Health Treatment............................................................................................58
Conclusion ....................................................................................................................61
Summary Report of Initial Site Visits: [Dr. Leta D. Smith]............................................63
Provision of Mental Health Care ................................................................................63
Adequacy of Policies and Procedures.........................................................................64
Quality Assurance and Peer Review Procedures ......................................................66
Mental Health Staffing ................................................................................................66


Sufficiency of Ancillary Staff ......................................................................................72
Training, Supervision and Discipline of Clinicians Supervision..............................73
Adequacy of Mental Health Records..........................................................................74
Crisis Management and Suicide Watch P & P ..........................................................76
Use of Mechanical Restraints on Mentally Ill Wards ...............................................78
Adequacy of Mental Health Care Facilities/Physical Plant......................................79
Adequacy of Mental Health Programs.......................................................................83

PROGRAMMING FOR JUVENILE SEX OFFENDERS ............................................................88
Assessment Protocol at Scioto............................................................................................93
Circleville Visit....................................................................................................................94
Programming ......................................................................................................................95
Privilege System ..................................................................................................................96
Therapist Contact Time .....................................................................................................97
Release .................................................................................................................................98
Miscellaneous ......................................................................................................................99


EDUCATION ....................................................................................................................................101
Leadership and Organization Structure...........................................................................101
Full School Day and Staffing..............................................................................................105
Special Education................................................................................................................109
Instructional Practices and Discipline...............................................................................113
Educational Assessment, Guidance Counseling & Reentry Services .............................116
Career-Technical and Job Training..................................................................................118
Educational Programs and Support..................................................................................120
Physical Plant ......................................................................................................................121
Supplements ........................................................................................................................123
Conclusion ...........................................................................................................................124


OVERCROWDING & STAFFING: TRAINING AND PROGRAMMING ...............................126
Training ...............................................................................................................................130
Training Remedies ..............................................................................................................135


HEALTH & DENTAL SERVICES.................................................................................................137
Health Services Overview...................................................................................................137
Current Structure of Medical Services .........................................................................139
Medical Assessments.......................................................................................................140
Recommended Improvements .......................................................................................141


Infirmary Care................................................................................................................143
Medication Administration ............................................................................................144
Laboratory Services........................................................................................................145
Infection Control.............................................................................................................145
Medical Equipment and Space ......................................................................................146
Documentation ................................................................................................................147
Quality Improvement .....................................................................................................150
Education on Health Issues, Medication, Nutrition, and Personal Hygiene ..............151
Mental Health Treatment Plans ....................................................................................152
Special Management Plans.............................................................................................153
Staffing for Physicians and Nurses and Related Areas................................................153
Nutrition ..........................................................................................................................155
Comments ........................................................................................................................155
Findings ...........................................................................................................................156
Dental Services Overview...................................................................................................159
Methodology and Techniques ........................................................................................161
Site Visits .........................................................................................................................162
Access to Care .................................................................................................................162
Quality of Care................................................................................................................163
Physical Resources ..........................................................................................................169
Human Resources ...........................................................................................................169
Dental Program Management........................................................................................172
Conclusion .......................................................................................................................173

RELEASE AUTHORITY.................................................................................................................174
Release Authority Functions ..............................................................................................176
Setting Dates........................................................................................................................176
Level of Service Inventory .................................................................................................177
Set and Forget .....................................................................................................................177
Release and Finances ..........................................................................................................178
Review Hearings .................................................................................................................178
Prior to PRD........................................................................................................................179
Perceived Needs...................................................................................................................180
Revocation ...........................................................................................................................180
Bureau of Parole Revocations............................................................................................181
Re-Offense Revocations......................................................................................................181


Summary and Recommendations......................................................................................182

GRIEVANCE PROCEDURE, YOUTH ADVOCATE, & DISCIPLINE ....................................185
Grievances ...........................................................................................................................185
Clinical Grievances .............................................................................................................191
J.P. Litigation ......................................................................................................................192
Youth Advocate...................................................................................................................192
The Disciplinary Process ....................................................................................................195


MISCELANEOUS ............................................................................................................................198
Lighthouse Youth Center at Paint Creek .........................................................................198
APPENDIX A: S.H. v. Stickrath Complaint
APPENDIX B: Ohio Statute § 2152.11
APPENDIX C: Community Corrections Report [David Roush]
APPENDIX D: Individual Team Member Reports
APPENDIX E: Mental Health Plan for Scioto (2004)
APPENDIX F: Conditions of Confinement Reports


S.H. v. Stickrath
Fact-Finding Final Report
December 13, 2007

United States Magistrate Judge Kemp appointed Fred Cohen as Independent Fact
Finder on May 18, 2007. Following an investigative protocol approved by counsel, I
assembled a team of 10 experts and we conducted intensive site visits of various Ohio
Department of Youth Services (ODYS) facilities, interviewing staff and youth; ODYS
officials were interviewed, records and various studies and reports were assembled and
studied, policy and procedure were studied and so on.
The Final Report is an amalgam of the entire team’s work. The individual expert
reports are assembled as Appendix D and properly may be viewed as resource material
for this Report. In the event of any real or apparent contradictions, the Final Report is
S.H. is a broadly drawn, multiple-conditions, class action case that includes all
youth who are or will be committed to the ODYS. The issues raised by Plaintiff’s
Complaint (April 4, 2007), include the application by staff of unnecessary force; arbitrary
and excessive use of isolation and seclusion; arbitrary and excessive discipline;
inadequate mental health, medical, and dental care; inadequate education services;
inadequate structured programming; broadly inadequate training of staff; an unsafe living
environment; and a dysfunctional grievance system. The Final Report addresses all these
areas and some other areas (e.g., Release Authority, grievances, and training) that are
inseparably related to the primary issues raised by Plaintiffs.
The Final Report sustains each area of the complaint, in varying degrees of
intensity. Should any of the findings be viewed as conclusionary, as not adequately
supported by its accompanying text, the read again is referred to the resource material in
Appendix D.
Most ODYS facilities were found to be overcrowded, understaffed, and
underserved in such vital areas as safety, education, mental health treatment and
rehabilitative programming.


Excessive force and the excessive use of isolation, some of it extraordinarily
prolonged, is endemic to the ODYS system.
Juvenile Correctional Officers (JCOs) bitterly complained about the excessive use
of mandated overtime, a practice at least partly driven by understaffing, which we
estimate to be 188 FTE, JCO positions. JCOs function now more like prison guards (or
police officers) than trained partners in a shared rehabilitative effort. Without additional
JCOs who are far better trained and psychologically equipped for this difficult job,
ODYS likely will continue to vacillate between the rhetoric of treatment and the reality of
the adultification of the agency.
With a population as psychologically undeveloped and damaged as the ODYS
youth, there must be a well-coordinated mental health system in place. Our experts
unanimously found, in effect, there is no mental health system. What goes by the name
mental health care actually is a series of well-intentioned responses to crisis.
One unsettling aspect of this constitutionally deficient mental health care is that I
co-authored a Report in 1998 and then prepared a more comprehensive Report in 2004
pointing out this same deficiency as to Scioto Juvenile Correctional Facility. I noted also
that there was a staff culture of violence there, a theme regrettably repeated in this Report
for ODYS as a whole.
There can be no claim of lack of knowledge regarding the paucity of mental
health care. Indeed, even as we visited Marion in recent months we found conditions in
the so-called Intensive Mental Health Unit appalling. DYS officials seemed caught off
guard at this revelation and then worked furiously to find a solution. On December 17,
2007, with just two hours prior notice, team member Barbara Peterson paid yet another
visit to Marion and the Intensive Mental Health Unit. Ms. Peterson found encouraging
changes: additional office space, new carpet, additional clinical staff, and evidence of
important advances in treatment planning and programming. (Brief Report appears as
part of Appendix D to this Report.)
For mental health and rehabilitative care to meet minimal constitutional standards
there must first be dynamic leadership in Central Office; a reinvigorated and broadly
shared sense of mission; the addition of clinical staff, especially psychiatric nurses and
child-adolescent psychiatrists; a continuum of care from reception to the home facility;


authentic mental health units; access to hospital level care; quality assurance, peer
review, and discharge planning.
The needless and excessive use of force is engrained within ODYS, with Ohio
River Valley, Marion and Indian River in the top tier on use of force, restraints, and
isolation. We consistently found flawed training, deficient oversight, seriously
inadequate reporting and subsequent review of “incidents.” Our findings support the
conclusion that ODYS youth, with varying degrees of intensity depending on the facility,
are not provided with the constitutional minima relating to a safe environment. Their
physical and psychological well-being is at risk and often damaged at the present time.
This environment, in turn, dramatically impedes whatever efforts are made to provide
treatment and programs.
As we note in the Report, we do not underestimate the daunting task faced by
ODYS, especially the JCOs, in dealing with this often difficult population. Staff,
however, cannot demean, provoke, insult and assault youth and then complain about a
violent environment. We found that JCOs’ training and early indoctrination emphasizes
a “we-they” attitude and a youth’s sidelong glance or delay in following an order is then
processed as a prelude to a dangerous encounter.
Too often it is because some officers do not know how to, or care to, de-escalate.
JCOs have a legal obligation to sustain a safe environment for the youth. In doing so, the
JCOs will create a mutually safe environment. Reinvigorated pre-service and in-service
training of staff on use of force is essential and a high priority.
Isolation, particularly in conjunction with various special management or
behavior plans, is used too often, for too long, and without adequate treatment or
educational opportunities. The extended — at times, months on end — use of isolation
(i.e., segregation) must be immediately revisited and dramatically changed. Imposing
prolonged and highly deprivational isolation whether in the name of treatment, behavior
modification, or punishment is not constitutionally permissible.
Our education expert, Ava Crow’s full Report on education is must reading. It is
attached as part of Appendix D. While Ms. Crow is sanguine about the leadership
prospects under new Superintendent Turner, there is little else she found that was
affirmative or in compliance with some important legal requirements.


ODYS’s top-down management style is found to give too little decision-making
to education officials. Ms. Crow’s full report provides numerous examples of the
difficulties this causes.
There are far too few teachers and substitutes, a lack of schoolroom, office, and
administrative space. On a randomly selected, given day, 43% (598 youth) were found to
receive less than the legally mandated, full school day.
ODYS is not meeting the mandates of various special education laws; the failure
to implement the requisite IEPs is but one dramatic example.
Disciplinary issues abound making education in ODYS facilities an often
harrowing task. Increasing disciplinary responses to student misbehavior does not seem
to be the answer. If the education mission is to go forward, this area is one of the crucial
areas for immediate resolution.
The system lacks academic and career technical counseling making re-entry
difficult for some, impossible for others.
In sum, the human and physical resources devoted to educating ODYS youth
along with the physical plant are utterly deficient and require basic overhauling.
As for facility overcrowding, only Mohican and Circleville operated under
capacity. The other facilities operated at 141% of rated capacity. When overcrowding is
combined with a staff culture overly reliant on the reflexive and excessive use of force,
this creates a combustible mixture.
With overcrowding, youth privacy is impacted, programs suffer, injuries increase,
staff suffers, and, in effect, any commitment to “help” is impaired. The reduction of
overcrowding, addition of staff, and richer programming is in the best interests of the
youth and often overwhelmed staff.
In considering the estimated JCO staffing shortfall, any resolution of the S.H.
litigation should consider population restrictions or reductions and/or greater use of
Community Correction Facilities, which our compressed examination rated quite
favorably. Any agreement concerning staff should occur within the framework of any
new direction ODYS may elect to take and such additional study of staffing needs that
the parties may elect to undertake as a part of a settlement agreement.


Also, a change in the job description and performance of JCOs seems vital. That
is, there should be a movement from “cop” to “counselor.” The parties should consider
changes in recruitment and compensation in order to attract and retain highly qualified
people for this very difficult job.
Excessive use of force, basically inadequate mental health treatment and
rehabilitative programs, and the marginal functioning of the education system are the
primary deficits of ODYS. If the system elects to continue to function within its present
outline, there must be a major change in training, recruitment, the hiring of additional,
qualified staff, quality assurance and peer review that is effective, and more evident
leadership at the Deputy Director level.
Director Stickrath has a daunting task with the agency he inherited and he appears
committed to leading the agency through the legally required changes and beyond. He
must receive the necessary support staff and funds to move forward. He should be
congratulated for continuing a policy that generally prohibits “handchecking” (requiring
youth to move about in a simulated handcuffed position) and allowing youth to converse
during meals, something not allowed by his predecessor.
As for medical and dental care, the Report makes it clear that the Medical
Director spends too much time providing direct care and this, in turn, impairs his ability
to provide needed leadership. There are problems with initial health appraisals, failure to
document basic clinical information, chronic care is seriously compromised, medication
administration is below accepted practice standards, infection control is compromised,
quality assurance is lacking, medical education for youth needs to be enhanced, and
professional staffing levels are inadequate. [See Final Report, page 152 for details.]
The overall ODYS dental care program was determined to be inadequate. There
are, however, sufficient numbers of dentists if they are supplemented with now nonexistent dental hygienists.
“Changes need to be made in the areas of: staffing (dental assistant),
diagnostic radiography (pre-extraction radiographs), infection control
(labeling of biohazards, sterilization of instruments, spore testing, gowns
and patient eye protection) urgent care tracking (complaints of pain
assessed, and consistently stabilized and documented by nursing or dental


staff within 24 hours), primary prevention (fluoride treatments and
sealants, annual prophylaxis and adequate oral health education, access to
dental floss), categorizing treatment priorities-secondary prevention
(caries stabilization-secondary prevention, annual follow up exams,
fabrication of partial dentures without caries stabilization), dental record
documentation (treatment plans, SOAP format), and access to care
(written and verbal instruction on the specifics of requesting emergency,
urgent and routine dental care).” [Final Report, page 167.]
The impact of the Release Authority (RA) reverberates throughout the entire
ODYS system. It is at the center of an arcane, legislatively created maze touching
judicial and administrative decision-making. For ODYS youth, the time added by the RA
to the presumptive release date was a recurrent source of agitation and confusion.
Where youth were delayed in program completion and the delay was not
attributable to the youth, frustration with deferred release was at its highest.
A recent Report on the RA by the University of Cincinnati (Professor Ed Latessa,
et al.), found that from July 1, 2003 to November 30, 2006, ODYS youth spent 2,092
years beyond what the so-called matrix (i.e., presumptive release date) prescribed. See
Edward Latessa, et al., An Analysis of the Ohio Department of Youth Services Release
Authority’s Decision Marking Process, pp. 16-19 (November 2007)(received by us on
November 21, 2007, after the RA section for the Final Report was completed.)
The Final Report describes the Ohio law on point as confused and regressive.
Protection of the public is rhetorically mixed with concern for the development of
children; accountability competes with rehabilitation. The allocation of dispositional,
release, and community supervision discretion between the judiciary, ODYS, and the
Release Authority is almost impossible to decipher, let alone detect some coherence.
Ohio, like a number of states, is constitutionally free to use a discretionary release
authority such as the RA. The Report points out, however, that the functioning of the RA
contributes to the uncertainty and confusion of the youth in the system and it urges that
the RA itself be closely re-evaluated.
The “Latessa Report” did not have crucial data on treatment services and
completion of services; it never mentions the impact of extended terms on the youth, and


simply accepts the matrix as a given rather than addressing the inherent value to juvenile
justice of presumptive sentences. Any future evaluation must assess the continued
viability, certainly in its present structure, staffing, and operation of the RA.
While there is no constitutional obligation to have a grievance system, the system
now in use does not appear to function as a viable problem-solving mechanism. Too
many JCOs simply brush off simple requests by youth by saying, “File a grievance, I’m
too busy.”
A good many ODYS youth have great difficulty in writing a coherent grievance,
orally presenting their “case,” and in pursuing an appeal. There is, however, no
mandated assistance for such youth. Grievance coordinators have varying backgrounds
and an ambiguous role. Grievances too often go unanswered or are answered late. We
did note some progress in enhancing timeliness. ORV remains particularly vulnerable in
its handling of grievances.
There is a Youth Advocate position within ODYS that consists of one person, a
car and a cubicle. Obviously, the incumbent cannot travel the state by himself and with
no support staff he inherently is unable to serve as a viable Ombudsman.
Looking at the grievance system and the Youth Advocate position as attempts to
defuse conflict; resolve individual complaints; and identify, then resolve systemic
problems, it is our finding that those objectives are not being achieved.
In conclusion, the allegations in the Plaintiffs’ complaint are essentially supported
by this Report. It is now up to the parties to construct a remedy consonant with these
findings. A remedy may track, and improve on, the existing architecture of ODYS or it
may seek a broader reform by, for example, moving increasingly to a community-level of
care with smaller, local, richly staffed facilities.
An earlier draft of this Report was submitted for review by the Defendants to this
action. This led to a face-to-face discussion of various points by Fred Cohen and Barbara
Peterson along with Director Stickrath and his staff and his counsel, Joseph Mancini.
Some adjustments have been made to the earlier draft and in the areas of treatment and
education I elected to include in whole or in part submissions from DYS.
In this Report we want to recognize the number of people we encountered within
the system — from JCOs to clinicians to Central Office — who do heroic jobs. For a


JCO to stand-up for a youth, for example, in the face of derision from colleagues is a
heroic act. For a psychiatrist to go to work every day, and work incredibly long hours, in
a system he or she knows is dysfunctional is truly heroic. For teachers to show up in
classrooms with students often less than enthusiastic about learning also is heroic.
As ODYS moves forward, it must build on these heroes and heroics. They must
become the models for change and their exemplary efforts the norm. We also believe
that Chris Money, the relatively new Superintendent at Scioto, has gained traction and
she, along with Deputy Nan Hoff, represent the hope for the future at their respective
Finally, the Paint Creek facility, with its low recidivism rates, intensive
programming, and rich staff may be viewed as an important model for Ohio’s juvenile
facilities. Our brief site visit and investigation led to some very positive findings but I
concede that further evaluation would be necessary before any wholesale adoption of the

Fred Cohen, Esq.
January ___, 2008


S.H. v. Stickrath
December 13, 2007

I am privileged to present to the Court and the respective parties in the above
captioned matter, the Final Fact-Finding Report (Report) required in accordance with the
Case Management Plan filed with the Court on May 18, 2007. S.H. v. Stickrath, in brief,
is a class action encompassing all persons who are or will be committed to the legal
custody of the Ohio Department of Youth Services and housed in the various facilities it
operates or contracts with.
The Court certified the class on July 9, 2007 pursuant to a Motion for an Agreed
Upon Classification Order.
The Second Amended Complaint in this mater was filed with the Court on April
4, 2007 and is attached hereto as Appendix A. [That complaint mistakenly describes the
lead Plaintiff as “S.W.” I will refer to the case as S.H. throughout.] The Complaint
accurately may be characterized as a broad-based conditions lawsuit.
Class counsel allege that the youth are subject to unnecessary force; arbitrary and
excessive use of isolation and seclusion; arbitrary and excessive discipline; inadequate
mental health, medical, and dental care; inadequate education services; inadequate
structured programming; broadly inadequate training of staff; an unsafe living
environment; and a dysfunctional grievance system.
Appointed as Independent Fact Finder by United States Magistrate Judge Kemp
on May 18, 2007, I prepared an investigative protocol that has been approved by counsel
for the parties. In brief, that protocol calls for site visits to the various DYS facilities
whereby youth and staff are interviewed; relevant files, protocols, and policy and
procedure studied; facilities inspected; and relevant activities observed.
Given the scope of the issues raised by the Complaint, with the approval of
counsel, the following experts were retained to serve as members of the investigative


Kathryn A. Burns, M.D., M.P.H.


Fred Cohen, LL.B., LL.M.*


Ava Crow, J.D.


Edward J. Loughran, M.A.*


Steve J. Martin J.D.*


Barbara Peterson, R.N.*


Robert A. Prentky, Ph.D.


David W. Roush, Ph.D.*


Donald Sauter, D.D.S., M.P.A.


Ronald Shansky, M.D.


Leta D. Smith, Ph.D.*

(* Indicates member of the “core team.” Medical, dental, sex offender programs, and
education specialists were given site visit schedules different from the core team.)
The “core team” visited Scioto, Marion, Freedom Center, Circleville, Ohio River
Valley, Mohican, and Indian River.
Ava Crow, our education specialist, visited Scioto, Marion, Freedom Center,
Circleville, Ohio River Valley, Mohican, Indian River, and Cuyahoga Hills.
Ron Shansky, M.D. and Don Sauter, D.D. S, accompanied by Barbara Peterson,
R.N. of the core team, visited Scioto, Marion, Ohio River Valley, Indian River, and
Cuyahoga Hills. It was my judgment that the medical and dental allegations could be
fully understood without visiting all the DYS facilities. I was prepared to have the
“medical/dental team” expand their site visits if it appeared to be necessary. In our
collective opinion, we learned enough from what was done to feel comfortable with our
fact finding and conclusions.
Barbara Peterson visited Paint Creek, a privately operated facility, on October 2,
Finally, Robert Prentky, Ph.D. was retained as our expert on sex offender
classification and treatment. He is a world-renowned expert in the field and he
constitutes an expert “team” of one. I asked Dr. Prentky to visit Scioto and Circleville
and study relevant policy and procedure as well as the all important assessment tools.


These facilities are most involved with sex offender treatment, especially Circleville, and
while other facilities may have offenders who receive sex offender treatment, it was my
judgment that study of the facilities described above would be adequate for our fact
finding and conclusions.
On November 2 and 3, 2007, the core team, absent Ned Loughran, along with
Ava Crow, met with Fred Cohen in Tucson, Arizona. This was a highly productive,
cross-fertilization meeting.

The table below reflects all site visits completed by all teams:
DYS Facility
Cuyahoga Hills
Freedom Center
Indian River
Ohio River Valley
Paint Creek



September 11-12
August 8-9
August 1
August 30-31
August 2-3
August 28-29
September 13-14
June 13-15 &
July 31-Aug. 1

August 6-7
September 19-20
July 30-31
October 2
September 17-18


Sex Offender

August 6-7
July 30- Aug 1
July 26-27
August 22-24
August 15-17
August 20-21
August 8-10

September 22-23

July 24-26

September 21

Additionally, Kathy Burns visited Scioto on August 27-28 and Marion on August 29-30

There have been a number of other investigative activities that we have engaged
in that also form a basis for this Report: interviews at Central Office with the Director
and his ranking staff, field interviews with staff, discussions with other persons and
academics familiar with DYS, legal and policy research, and more.
While this is likely to sound like the empty, typical, “thank you to all,” it is not.
Director Stickrath could not have been more helpful and supportive of our efforts and for
that we all offer our heartfelt thanks. The Director assigned Ms. Shelly Fitzhugh to serve
as the agency’s point person with the team. She gathered data, worked on travel and
interview schedules, answered questions, and made our difficult job much easier. Ms.
Fitzhugh attended the above noted meeting in Tucson at the invitation of Fred Cohen and
was present at all of our deliberation. She also has our heartfelt thanks.

Counsel for the plaintiffs and the Attorney General’s office have been a pleasure
to work with. These are all professional and honorable members of the bar who pursued
our non-adversary, collaborative approach in a highly principled fashion while never
appearing to lose sight of the interests of their clients and the youth who constitute the
Finally, a special thanks to Linda Mitchell, my Staff Director and all-around
assistant, for word processing, organizing, and producing this Report.

Respectfully submitted by:

Fred Cohen, LL.B., LL.M.; Independent Fact-Finder

Who is grateful for the expert assistance of:

Kathryn A. Burns, M.D., M.P.H.
Ava Crow, J.D.
Edward J. Loughran, M.A.
Steve J. Martin J.D.
Barbara Peterson, R.N.
Robert A. Prentky, Ph.D.
David W. Roush, Ph.D.
Donald Sauter, D.D.S., M.P.A.
Ronald Shansky, M.D.
Leta D. Smith, Ph.D.



A Damaged Population
The allegations made in the Complaint with varying degrees of intensity are
essentially supported by our findings. Perhaps our gravest concern relates to staff use of
force, isolation and restraint. The paucity of mental health care we uncovered lacks the
drama, the shock value, of youths being taken to the floor by staff and placed in
dangerous chokeholds, youths suffering a variety of broken bones and dislocations due to
needless and dangerous physical restraints; plainly disturbed youth locked into
segregation cells for 23 hours a day, 7-days a week for months on end with no semblance
of needed treatment — and more, as will be developed, infra.
I might add here that the Mohican and Circleville facilities were found to be much
more moderate in the use of force and various types of restraint. It is no accident that
these DYS facilities also are the most treatment oriented. This will be more fully
developed also, infra.
The youth confined within the ODYS system are, of course, not strangers to abuse
and violence; to feelings of worthlessness and for some, an almost reflexive reaction to
violence with violence. It is our premise that the persistent and deeply rooted culture of
DYS staff violence either breeds, and most certainly reinforces, youth-on-staff and youthon-youth violence.
Whenever this writer conducted group sessions with youth, the question would be
asked, “How many of you experienced sexual or other physical abuse while growing
up?” I cannot recall having fewer than half the youth answer, “yes” and with the girls
confined at Scioto, the “yes” fell into the 80%-plus range. I understand this is not a
scientific study and the term “abuse” may have a different meaning to different youth —
typically as to the degree of the battery and consequent injury — but the answers of these
young people give color and tone to some of the bland statistics residing in the scientific
Institutions housing juvenile delinquents are not alone in the mistreatment of
youth. Testimony before the House of Representatives, Committee on Education and
Labor described thousands of allegations of abuse of troubled youth housed in residential


programs across this nation. These facilities did not include public programs or systems
such as DYS. 1
The GAO conducted the study leading to the testimony and, inter alia, found that
in 2005 alone 33 states reported 1,619 staff members involved in the abuse of youth
housed in residential programs; and in 10 selected, closed cases involving the death of a
youth, significant evidence of mismanagement was found including the hiring of
untrained staff.
There are no federal laws that regulate and define residential treatment programs
for youth.
A recent series in the New York Times discloses shocking abuses in New York
City’s well-intentioned child foster care program. 2 Children are found malnourished,
burned, abused, and dead. Oversight is virtually non-existent and media-cultivated child
advocates are uncovered as fraudulent, profiteering schemers.
The air is filled with rhetoric of abiding concern for our children. And then there
is the sobering practice of providing the least for those most in need. The troubles we
identify at DYS are not isolated. They reflect the failure of social welfare and social
control policies. States do not frame child welfare policies — certainly not for juvenile
justice — in terms of child welfare preferring instead an emphasis on crime control.
Poverty is the single biggest risk factor for youth and poverty disproportionately
affects minority children. 3 The population of minority youth in the custody of DYS
reflects this imbalance. 4
In 1988, Congress amended the Juvenile Justice and Delinquency Prevention
(JJDP) Act to require states receiving federal funds to ensure equitable treatment on the

Residential Treatment programs: Concerns Regarding Abuse and Death in Certain Programs for Troubled
Youth (October 10, 2007) available at GAO-08-146T.
Leslie Kaufman, Foster Children at Risk, and an Opportunity Lost, (NY Times, Nov. 5, 2007), available
See Barry C. Feld, Bad Kids: Race and the Transformation of the Juvenile Court, pp. 331-345 (1999).
Professor Feld calls for the abolition of the juvenile court as a device to uncouple social welfare and social
control policies. He notes the significance of “gun crimes” by juveniles and the impact this has had on
disposition practices. In Ohio, “gun spec” offenses have led to increased minimum sentences and
influenced the control tactics of the Release Authority.
In fiscal year 2006, 59% of the youth admitted to the DYS were Black, Bi-racial, or Hispanic. Whites
constituted 40.7% of admissions. Males constituted 92.2% of the admissions.
At the same time 85% of the Ohio population was white, and the above minority groups totaled only
15.5%. Adult and juvenile breakdowns for the overall population was not located.


basis, inter alia, of race and to assess the sources of minority overrepresentation in
juvenile detention facilities and institutions (42 U.S.C. Sec. 5633(a) (16) [Supp. 1993].
In response, a number of states examined and found racial disparities in their juvenile
justice systems. A review of these evaluation studies reported that, after controlling for
offense variables, minority youths were overrepresented in secure detention facilities in
41 of 42 states and in all 13 of 13 states that analyzed other phases of juvenile justice
decision making and institutionalization. 5
In the context of this lawsuit we cannot alter the socio-economic policies that
even directly influence the pool of eligibles for DYS jurisdiction. We would be remiss,
however, if we did not point to the larger context and clarify our belief that DYS is not
some isolated state agency that somehow malfunctions.
We do not underestimate the daunting tasks faced by ODYS in managing what is
often a difficult population. On the other hand, we did not look for extraordinary
performances producing miraculous outcomes. Staff, however, cannot demean, insult,
and otherwise provoke youth in their custody and then complain about a violent
environment. Staff cannot impulsively react to a youth’s self-destructive behavior with
needless physical force at times creating life threatening situations for the youth. The
three use of force examples contained on the attached DVD will illustrate needless,
excessive, and dangerous force more likely the product of a lack of training and effective
oversight than venality.
Staff may not be required to create dreams but they need not shatter them either.
Adolescents who speak of going home must not be told, “you ain’t got no home” or
“you’re a sex offender, who would want you released!?”
As novice JCOs launch their employment they are warned about the dangers they
will face; of the need to be vigilant, wary, and on guard. A youth’s sidelong glance or
seemingly mocking tone is elevated to a threat to survival. A youth’s refusal to follow an
order becomes a threat to one’s manhood and the forewarned dangerous environment
suddenly is real and the need to aggressively respond is at hand.


See, for example, Carl Pope, Racial disparities in Juvenile Justice System, ch. 5 Overcrowded Times,


DYS facilities, however, are not the street and not the officer’s home; these are
involuntary, custodial situations where the law governs use of force and not the street or
autonomy of the home rule. DYS facilities cannot be proving grounds for staff power.
That power exists, of course, but must first be used to de-escalate, to teach alternatives to
violence, and to use only that force that is minimally necessary to preserve order and to
protect life and limb.
As this lawsuit moves forward, a dramatic reduction in staff violence should be
the first order of business. It is difficult to imagine constructive mental health care,
rehabilitative programming, and effective education occurring where youth fear staff and
other youth, and staff fear youth.
Constitutional Standard on Safe Environment
This is a damaged population, some far more than others and, at a minimum, DYS
should echo the physician’s mantra: “First, do no harm.” The constitutional standard in
some of our areas of concern may be open to reasonable debate; e.g., the precise contours
of the right to, and constitutional basis for, mental health treatment. But the right to a
reasonably safe environment echoes repeatedly through the reported cases and the
combination of excessive force, restraint and isolation in ODYS is closely tied to the
right to be safe, the right not to be in constant fear and to not deteriorate. See Doe v.
Strauss, No. 84C2315, 1986 WL 4108, at *4 (N.D. Ill. Mar. 28, 1986) (unreported)
“[Concluding] that what we have here is a long elevated Fifth, Eighth and Fourteenth
Amendment right decisionally recognized in this state and many others. It protects
juveniles when they are placed by state action in special custody, management and
control because of their homeless, their delinquent conduct, and their unmonitored living.
It is a right to care, management and therapy reasonably designed and calculated to effect
rehabilitation, moral restoration and proper development.”
In K.H. v. Moran, 914 F.2d 846, 851 (7th Cir. 1990), the court held that
Youngberg v. Romeo, 457 U.S. 307, 315-16 (1982), made it clear that the Constitution
requires responsible state officials to take the necessary steps to prevent, inter alia, youth
in state institutions from deteriorating physically or psychologically. See also Mary and
Crystal v Ramsden, 635 F.2d 590 (7th Cir. 1980), finding that youth have a constitutional
right to be protected from harm inflicted by others. Coincidentally, Mary and Crystal


also determined that it could be a constitutional violation for a contract psychologist to
refuse to visit Mary while she was in prolonged isolation. To also suspend her from their
regular program of treatment while so confined added another dimension to the cruel and
unusual punishment she suffered. 635 F.3d at 598
Incidence of Mental Disorder
In considering the prevalence of mental disorder among the population of
incarcerated youth, there is virtual unanimity that it far exceeds the estimate of between
9% and 13% in the general population. Joseph Cocozza & Kathleen Skowyna, Youth
with Mental Health Disorders: Issues and Emerging Responses, 7 Juv. Justice 3, 4
(2001). For juveniles in confinement, the low estimate is 20%. Gail Wasserman, et al
found that 67.2% of youth in secure placements in Illinois and New Jersey met the
criteria for the existence of a psychiatric disorder in the preceding month: Gail
Wasserman, et al, Assessing the Mental Health Status of Youth in Juvenile Justice
Settings, Off. Juv. Just. & Delinq. Prev. 3 (June 2004).
The highly regarded Linda A. Teplin, studying youth in detention, found 66.3% of
the males and 73.8% of the females met criteria for a mental disorder or substance abuse.
Linda A. Teplin, Psychiatric Disorders in Youth in Juvenile Detention, 59 Archives of
Gen. Psychiatry 1133, 1136 (2002).
There are other studies where the estimates run as high as 76%. In our own work
in Ohio we found that for the 90 girls confined at Scioto as of June 2007, 80 were on the
mental health caseload (89%) and 66 were taking psychotropic medication (73.33%).
The males held in reception had much lower numbers, reflecting what I believe is a desire
to defer diagnosis and treatment to the ultimate home facility. Girls do, however, tend to
present with a much higher percentage of mental illness in juvenile and adult facilities.
Curiously, in 2007 conduct disorders, drug dependence, PTSD, and mood
disorders were the most common Scioto diagnostic categories while in 2004, almost all
the girls on the caseload were determined to be bi-polar. See, Fred Cohen, Interim
Report: Scioto Juvenile Correctional Facility: Girls Units, August 16, 2004 (hereafter
Interim Report). This reflects an issue that is endemic nationally to this area: lack of
clarity and agreement on what constitutes a mental illness along with diagnostic


Competing Models
These two factors lead to another salient observation the response to which will
have significant implications for this Report and any remedial agreements that may
follow. If the right to mental health treatment ultimately agreed upon here is limited to
the medical (or disease) model and kept within the limited boundaries of the Eighth
Amendment right for adults, the first limiting factor will be serious mental illness and the
other constitutional limiting factor would be the deliberate indifference, culpability
standard. See Fred Cohen, The Mentally Disordered Inmate and the Law, ch. 2 (CRI,
Inc., 1998 & 2003 Supp., Second Edition in 2 volumes, now “in press”).
Some argue that this limited legal and policy model is inappropriate; that an
expansive right to treatment for juveniles flows from the Due Process Clause and as an
incident to being civilly adjudicated as delinquent with the right to rehabilitation, then,
linked to the civil status of an adjudicated delinquent. See Fred Cohen, Ibid Section 20.3
[1] (2003 Supp.) 6
Rehabilitation, as used above, becomes the larger category encompassing the
medical model of treatment while also including a right to individualized care for the
entire set of behavioral problems linked to the youth’s delinquent behavior. Neither
serious mental illness nor deliberate indifference would be applicable. Each youth would
be entitled to an individual treatment or rehabilitation plan not dependent on shifting
diagnostic categories.
Education: Holistic Approach
Education usually is dealt with independent of a treatment or rehabilitative
concern. While there certainly are different legal mandates and objectives — e.g.,
achieving literacy — not usually packaged with treatment or rehabilitation, education
issues should be seen as part of the effort of DYS to enhance the opportunities of youth in
its custody to succeed, to avoid recidivating. As Professor Douglas E. Abrams writes, in
describing the much discussed “Missouri Plan:”


In a CRIPA letter to Governor Musgrove of Mississippi regarding the horrendous conditions in that
states’ juvenile facilities, the DOJ stated that the Constitution requires that youth confined at Oakley and
Columbia receive adequate rehabilitative treatment citing: Morgan v. Sproat, 432 F.Supp. 130, 1135-36
(S.D. Miss. 1977); Pena v. New York State Division for Youth, 419 F.Supp. 203, 207 (S.D.N.Y. 1976).


[Because studies] have shown that confined youths who participate in
educational and vocational training programs have lower risks of
recidivism, educational programming belongs at the forefront of
delinquency treatment and rehabilitation. Sound programming requires
qualified instructors, adequate books and other supplies, a student-faculty
ratio that permits individual attention, and clean classroom space
conducive to the educational enterprise. The task may be daunting because
so many delinquents enter state custody far behind in their studies and
prone to "act out." As in Missouri, educational programming should
exceed the bare constitutional and statutory minima by implementing
individual assessments completed when the youth is admitted to the
facility. (Douglas E. Abrams, Reforming Juvenile Delinquency Treatment
to Enhance Rehabilitation, Personal Accountability, and Public Safety, 84
Oregon L. Rev. 1001, 1081-82 (2005)).
In the Report (p. 35) prepared by Ava Crow, assisted by Anne Flynn, she notes
that 62% of all the DYS teachers express dissatisfaction with school safety. Her overall
assessment is equally grim. Federal requirements for special education students are
basically and systemically violated, security is found to trump education in most matters,
organization and administration does not now further DYS’s own goals, staff and space
are festering problems, youth placed in extended isolation are de facto denied education,
full school days generally are not provided, and virtually nothing is done to help youth
who are released successfully re-enter society.
Education obviously must be at the same table with mental health and
rehabilitation. Joint planning, implementation, and oversight are required and this, in
turn, requires more staff, more space, and more time to collaborate.
Our findings support the general observation that one is unlikely to find a facility
with a commendable mental health program but a singularly poor education and
vocational program. Indeed, where both components are substandard, there is likely to be
a corresponding over reliance on the use of force. Where both components are viable
then use of force correspondingly is diminished. As our educational expert, Ava Crow,
points out, those teachers rated most favorably as to their instructional process invariably


filed the fewest disciplinary infractions reports. When this Report moves into more
detailed discussion of these areas, it will become even clearer that these areas of concern
are interdependent.
The urgency of the excessive use of force problems dictates that it should be
among the first areas addressed for change but it does not also follow that excessive use
of force — like educational defaults — is somehow divorced from treatment,
rehabilitation, and education.
If I may then take this somewhat holistic approach one step further, I would add,
what the U.S. Department of Justice in its CRIPA letters and reports, describes as antitherapeutic conditions. See e.g., DOJ, Letter to Mississippi’s then Governor Musgrove
(June 19, 2003)(available at
The CRIPA letter notes that conditions at Columbia, one of Mississippi’s flawed juvenile
facilities, cause depression and mental deterioration. There is a lack of activity, social
interactions, counseling, undue restraint, and fear.
Similarly, and with broad variations in Ohio’s DYS facilities, there is a harshness
in the social climate that is created by verbally abusive and militaristic JCOs, the
imposition of group punishments (even though forbidden by rule), excessive amounts of
penal isolation — and more. In a recent, albeit undated, letter (p. 2) signed “The Staff at
Marion JCF,” the youth at Marion are described as “lost to society and will not, and
cannot be reformed no matter what new program is attempted.” Later, DYS youth are
described as a generation of violent predators treading water until release and the
opportunity to reoffend. This is not a promising basis for altering the current climate
within DYS.
The individual experts’ reports are replete with calls to expand the JCO role from
purely custodial to the inclusion of caseworker-like functions. This, in turn, would
enhance the professionalism of the position as well as the basis for compensation. This
call for “role enhancement” may be chimerical if the Marion staff letter expresses widely
held staff beliefs. Those attitudes, if unrestrained, can lead only to reform along a
heightened security-punishment model.


Team member Ned Loughran, in his “Summary Report” of November 12, 2007,
reached similar conclusions and also contrasted Ohio with jurisdictions attempting to
pursue a different path:
The Juvenile Correctional Officers (JCO), the direct care staff in every
DYS institution I visited, constantly interact with the youths throughout
the day but so little of their interaction fosters rehabilitation. The
correctional officer’s relationship with the youths is basically a custodial
one. Youths appear to be uncomfortable with staff and staff are
uncomfortable with youths. As long as uniformed correctional officers
perceive their role in the institutions to be correctional rather than
rehabilitative, the Ohio institutions will never become treatment programs.
Other states, such as California, Illinois and New Jersey that use
uniformed correctional officers who are trained primarily in carrying out
custodial duties, experience similar problems — high rates of use of
restraints and isolation and high rates of injuries to youths and staff - as
Ohio DYS. Staff and youth’s fear for their safety runs high in these
jurisdictions as well.
Many other states interpret the role of direct care staff philosophically
different from Ohio. These staff are called rehabilitation counselors in
Washington State, youth counselors in Pennsylvania, youth care workers
in Massachusetts, and youth correctional counselors in Oregon to name a
few jurisdictions. The various titles of direct care staff imply that their
role is rehabilitative not custodial. Staff do not wear correctional officer
uniforms but rather their own clothing. Pennsylvania outfits its youth
counselors with a golf shirt with a logo that identifies them as youth
development center staff.
Beginning in May 2007, ODYS began to replace the current prison-like JCO
uniforms with a civilian-type outfit consisting of a blue shirt and khaki pants. Director
Stickrath (by Memo to Staff, May 17, 2007) explained that this is part of a more
comprehensive effort to create a youth-oriented environment.


In my interviews with JCOs held in every facility that the core team visited, there
were three consistent views expressed: (1) Mandation (i.e., required overtime) must be
totally overhauled. (2) JCOs require training in use of force and the signs and symptoms
of mental illness, effects of medication, and non-compliance. (3) Staff numbers must be
I heard concerns about personal safety, gang problems, and difficulties in
managing some of the youth, but never to the extent of the defeatist, alarmist views
expressed in the Marion staff letter referred to earlier.
Thus, we can begin to embrace the interrelatedness of the seemingly disparate
allegations made in the Complaint and substantiated by our investigation. An
environment of fear; an environment where youths undergoing sex offender treatment are
told by some staff, “Why do you worry about going home? Nobody there wants you
anyway;” an environment where youth are physically subdued with life and health
threatening techniques is not an environment conducive to effective care and treatment.
It will be for the parties to ultimately reach agreement on the model for “treatment
v. rehabilitation” and the interrelationship of that model with education and use of force.
The staffing, training, programming and disciplinary implications of the choice of models
are profound. To the extent that the Marion staff letter reflects systemwide beliefs of
JCOs, there will be no “fix” without resolving the “mandation” issues; the underlying
attitude of “nothing works” and the belief that it is staff who are more at risk than the
Medical Issues
Juveniles have health problems that are different than adults simply because they
are still developing; brains are incomplete and bodies often not yet fully formed. Given
the demographics of an incarcerated juvenile population, the usual developmental issues
are exaggerated and the medical and dental needs of the population are much greater than
what might be expected.
The American Public Health Association encapsulates these needs in their
recently issued Standards.
Public Health Rationale: Children and adolescents are still developing
physically and mentally. They may have health problems that are


different from those of adults and that require the care of physicians and
other health professionals with training and experience in adolescent care.
In addition, incarceration itself may have a more serious emotional impact
on youth than adults.
Youth in the justice system have substantial health needs. Dental, mental
health, and substance abuse problems, including the abuse of tobacco, are
widespread. Many of the most common medical problems (i.e., traumatic
injuries, sexually transmitted diseases, and pregnancy) are directly related
to impulsive, high-risk behaviors associated with immaturity.
Dental caries (soft, decayed area in a tooth) and fractured front teeth are
the most common physical health problems among incarcerated youth.
Moreover, adolescence is the age of greatest incidence of caries in the
permanent molar teeth. Filling existing caries and application of pit and
fissure sealants to intact molars are highly effective interventions to stop
further deterioration and preserve the permanent teeth into adult life.
Asthma is the most common chronic medial condition among young
people, but there are a wide variety of other chronic diseases and disabling
conditions originating in childhood. For example, many of the chronic
illnesses commonly associated with middle age first appear in
adolescence. Early diagnosis, patient education, and effective management
of diabetes, hypertension, hyperlipidemia, and smoking beginning in
adolescence will prevent or reduce serious end-organ damage later in life.
Children have limited experience with and knowledge of health care
issues. Emotionally immature and impulsive youth react very poorly to
demands or ultimatums from institutional authorities. Health care staff
needs to take a developmental approach to youth by answering questions
truthfully, patiently explaining the reasons for necessary procedures or
medications, and offering alternatives. It is not uncommon for a youth to
adamantly refuse care at one moment and then request services a short
while later. (American Public Health Association, Standards for Health
Services in Correctional Institutions, Standard VII.B (2003).


As will be discussed, infra, our findings indicate there are substantial problems in
the provision of medical care in the DYS system. In particular, a chronic care system
does not exist and significant problems exist as to the prescription, distribution, and
storage of medication.
We found no evidence of a sustained effort to provide these youth with a health or
dental education program. We did not detect a strong leadership role on those issues, or
the requisite oversight, emanating from Central Office.
Ohio Law: Confused and Regressive
The statutory law of Ohio certainly does not help to resolve any of the dilemmas
associated with following a coherent, consistent rehabilitation or treatment goal. Ohio
Revised Code Annotated (ORCA) § 2152-01(A) provides, in part:
(A) The overriding purposes for dispositions under this chapter are to provide for
the care, protection, and mental and physical development of children subject
to this chapter, protect the public interest and safety, hold the offender
accountable for the offender’s actions, restore the victim, and rehabilitate the
offender. These purposes shall be achieved by a system of graduated
sanctions and services.
Here, at least some homage paid to the care, protection, and development of youth
brought into the juvenile justice system. This mixed commitment to the youth, the
victim, and public safety threads its way through the labyrinth of the Juvenile Code with
concern for the youth gradually giving way to a victim-oriented, public safety, penal code
model. At ORCA, Section 5139.50 et seq., dealing with the Release Authority, the
criminal law model is rather clearly established. At Section 5139.51(A), for example,
discussing the release or discharge of a youth, there is provision for notice of
consideration of release or discharge to the committing court, prosecuting attorney, and
the victim. I find no mention of such notice to the youth’s parent, guardian, attorney, or
other mature person upon whom the youth may rely. (The latter term is used in the ABA,
Juvenile Justice Standards Project to describe a mature friend not legally connected to the
In re C.S., 874 N.E.2d 1177 (Ohio 2007) grappled with some complex issues
related to a juvenile’s constitutional right to counsel in a delinquency proceeding. While


affirming the importance of the right, the Supreme Court of Ohio held the right could be
knowingly and voluntarily waived and while a parent cannot “represent” their child they
may play an important role in the waiver decision.
The supreme court also made clear that while the juvenile code may have taken
on some characteristics of a penal code, it remains “an administrative police regulation of
a corrective character.” The majority opinion reflects an oft-stated judicial view of
juvenile justice: While rehabilitation may not be the only goal, it remains the primary (or
important) goal.
The allocation of dispositional, release and community supervision discretion
between the judiciary, the agency, and the Release Authority is almost impossible to
decipher, let alone detect some coherence. One point does emerge, however, and that is
the “rehabilitative ideal,” slowly gives way, as noted, to a criminal law-like Code. I
would assert that the punitive aspects of the DYS culture, the very architecture of such
facilities as Marion and Ohio River Valley, the security staff wearing of prison guard
uniforms, the emphasis on punishment, responsibility and security cannot be detached
from a Juvenile Code that is more criminal than juvenile.
ORCA Section 2152.11 “Range of dispositions of child adjudicated delinquent” is
illustrative both of the criminal law flavor of the Juvenile Code and its Byzentine
complexion. 7 This Section is offense- and age-based in its allocation of judicial
dispositional discretion. It must then be configured with other provisions of law relating
to the power of the Release Authority and DYS with its time enhancing authority
exercised incident to disciplinary proceedings.
If we add the bewildering issues related to detention credit to this maze, the spiritsapping complexity of the Ohio system becomes even more apparent. Team member,
Ned Loughran, in his Scioto Site Visit Report (Aug. 26, 2007) writes:


For example: A youth is committed to DYS by the court for 9
months. The youth earns 60 days of detention credit (DC), which
brings his commitment down to 7 months. The DYS Release


The entire Section is reproduced as Appendix B.


Authority (RA) must conduct a release review for parole at the
minimum sentence – in this case 41/2 months. In this scenario, a
youth could be up for release review while still in the reception

Extreme example (actual case): Youth entered reception center on
6/27/07 with 148 days of DC on a six month commitment, having
already passed the mid-point in his sentence. His minimum
sentence is August 5. He needs a release authority review before
he can be placed on parole. The RA can give him additional days
by utilizing the “matrix” looking at the presenting offense, the
victim, age of victim, whether or not there was injury to the victim
and whether or not a weapon was used to commit the crime. The
RA can defer the parole decision based on treatment needs and a
youth’s behavior.


Example of a county giving detention credit: A youth in a county
detention center is committed and placed on probation, i.e.,
supervised in the community by the court. The youth’s probation
is violated and he ends up back in the detention center. He is
ultimately committed to DYS. The DC clock begins at the first
instance of placement in detention. And some counties give DC
for placement time whether it’s in the community or a detention
center. The incentive for the county to give DC credit for any
placement is because the county pays for the bed up to the sixmonth or one-year sentence the judge imposes on the youth. After
that DYS pays for the bed.

The court sends data to the reception center via the Journal Entry. DYS
has created a form called the Detention Credit Addendum to close the gap


between information received on the journal entry and the actual credit
that the court intended to record on the journal entry.

The formula: detention credit begins to accrue from the day the
youth is taken into custody and the day the youth is committed to
DYS. Add to the time in detention prior to commitment the time
between commitment to DYS and admission to the reception


The journal entry from the court doesn’t always have DC days


Often times the reception center receives conflicting information
from the courts between what is in the journal entry and what the
Detention Addendum states.


The way the county (Probation Officer and others) records DC
information sometimes is not consistent with the information on
the journal entry and Detention Credit Addendum


Youths can appeal their DC by filling out a request to speak with
legal counsel


The Detention Credit Addendum does not have the date the youth
entered detention and the date he left for the reception center.


The Catch 22: The Detention Credit Addendum was developed to
close the gap and get additional information for the purpose of
awarding the correct DC. Now the counties are not recording the
information in the journal entry and waiting to include it on the
Detention Credit Addendum. Not getting the information needed
to assess DC wastes time and impacts the time that DYS has to
treat youths. (Loughran, Scioto Report at pp. 9-10)

The youth in this system are utterly bewildered by this dispositional scheme.
They repeatedly expressed to us their confusion; their feeling that the release and retain
system is arbitrary and not particularly concerned with helping them. Not knowing if and
when you are “going home” and not grasping how and why that decision is made and


then remade, in our view, creates yet another, and significant, barrier to the rehabilitation
of these youth.
We understand that not all these structural-legislative issues are directly a part of
the litigation at hand, yet we would be remiss if we did not call attention to these matters
since they create a framework within which this litigation is played out.
Guarino-Ghezzi and Loughran, describing the Ohio Juvenile System in 1994,
found 1800 youth in institutional settings (the approximate same number as of September
2007). Ohio is described as moving toward improvement in institutional programming
and community alternatives. The authors wrote hopefully about unit management;
specialized treatment; two new facilities designed to accomplish downsizing, more
programming, and better medical and mental health treatment. Susan Guarino-Ghezzi &
Edward J. Loughran, Balancing Juvenile Justice 43-44 (1996).
Ohio River Valley (ORV) and Marion Juvenile Correctional Facility (Marion)
were opened in 1996 and 1999 respectively. Whatever the ceremonial rhetoric, one
glance at their architectural plans would disclose that each facility is designed as a very
secure prison. Sad to say, our site visits disclosed that these new facilities are among the
leaders in gratuitous staff-on-youth violence and are almost devoid of meaningful
These facilities are the architectural embodiment of what S.H. team member,
Dave Roush, terms the adultification of Ohio’s juvenile justice system. Scholars, like
Professor Barry Feld, argue that “juvenile courts punish delinquents in the name of
treatment but deny to them the protections available to criminals.” Barry C. Feld, Bad
Kids: Race and the Transformation of the Juvenile Court 288 (1999). 8 Feld despairs of
legislators who are unwilling to provide for the welfare of all children providing for
children who are delinquents.
This writer spoke at length with a 15-year resident who had been confined in
ORV’s Special Management Unit for about four months. This meant confinement in a
small, barely furnished segregation cell for 23 hours a day, 7 days a week. A level
system does allow youth to regain some freedom and amenities in two-week, discipline8

See e.g., Aaron Kupchi, The Decision to Incarcerate in Juvenile and Criminal Courts, 31 Crim. Justice
Rev. 309 (2006), finding no differences among factors predicting sentencing across these two supposedly
distinct legal forums.


free increments. The level system itself lacks any meaningful, procedural fairness,
treatment team input, or oversight.
ODYS’s current practice of isolating youth in these special units by whatever
name the practice is given, is unconstitutional on its face. Extended room isolation or in
cells resembling those in use at Ohio’s Supermax (OSP) is a practice that should
immediately cease.
Adequate treatment and educational opportunities in the isolation unit simply
were not present. What was called a treatment team met weekly without the youth or a
psychiatrist and functioned essentially as a unilateral classification-program committee.
Marion’s Intensive Treatment Unit was similarly secure and similarly without
adequate treatment. We observed a tape of a slight, 15-year-old youth who had “cut”
being subjected to a needless, life-threatening effort by five staff members to apply
leather restraints. Only when the youth instructed the staff, including a Unit Manager, on
how to apply this particular restraint did the horrifying, 35-minute incident conclude.
This same mentally ill youth later, and coincidentally, was observed during a
disciplinary hearing charged with creating an “institutional hazard;” that is, cutting on his
arm. The youth had no one to assist him; he was not informed of the potential
consequence of a plea, which he quickly entered; and he was not competent to challenge
self-injury by a mentally ill youth as inapposite for a possible, sentence-lengthening
The youth slowly withdrew as the hearing droned on; gradually settling into
putting his head down into the arms he had enfolded at his desk. This, in my view, was
not an act of official venality. It was more likely a rigid adherence to a one-size fits all
disciplinary proceeding; it was the conversion of a therapeutic opportunity into a
psychologically hazardous event. It lacked elemental fairness and even a semblance of
rationality. It became all too emblematic of this facility.
The likelihood of settlement negotiations in S.H. was the stimulus for my modest
effort to gain some understanding of Ohio’s Community Corrections Facilities (CCFs).
To that end, I asked team member, David Roush to briefly visit the Northern Ohio
Juvenile Community Corrections Facility in Sundusky and the facility in Canton.


His Report of October 19, 2007 is attached as Appendix C. He noted that both
facilities operate very good treatment programs; that the small units are well staffed;
youth were polite, well mannered, and felt “safe;” and that the education program at
Northern Ohio could serve as a model.
There is more and it is all positive. Should settlement discussions include
downsizing and a greater reliance on a community-based model, it would appear that
Ohio’s CCFs should be very seriously considered as models.
In the succeeding sections of this Report, we will use an area, or topical, approach
as opposed to a facility-by-facility approach. We will provide sufficient examples to
support a particular finding but readers should be aware that the individual Reports,
attached as Appendix D, and the notes of the experts will contain even more examples of
case studies and observations.
The direction of this Report has been discussed by most of the Team during a
two-day meeting (Nov. 2-3, 2007) held in Tucson, Arizona. This de Facto is the Report
of the Team, although the Principal Investigator, Fred Cohen did the bulk of the writing
and it is submitted in his name. Readers will detect a certain unevenness in length in the
various Sections that follow. The fact that one section has far more space devoted to it
than another is not by itself indicative of relative importance. I did not impose any rigid
limits on team members’ reports and, frankly, some just wrote more than others and I
wielded a lighter editor’s touch than I might have.
As such, the writer accepts responsibility for any errors or editorial lapses that
may be found. At the same time I wish to thank the members of the S.H. investigative
team for the high level of professional work reflected in their deadlines I felt constrained
to impose.



Safe Environment
A safe environment is a necessary albeit not sufficient requirement for achieving
any positive results with the youth entrusted to the custody of the Ohio DYS. Our initial
site visits were to Scioto and they sparked some hope that DYS might have turned the
corner in this area.
A new Superintendent, Chris Money, the eighth in seven years, is widely admired
for her work with adult prisoners and then in the Central Office of DYS. Her Deputy for
Direct Services, Nan Hoff, appears wholly committed, not merely to the safety of the
Scioto girls but to helping them. The majority of the Scioto girls that I interviewed
individually and in groups answered yes to the question: Do you feel safe here?
In August 1998, acting as consultants to the then Director of DYS, Dr. Jane
Haddad and I wrote:
[L]ine staff follow a “control model” rather than a “treatment model” and
especially during hours when administrative and clinical staff are not
present. Indeed, we may go further and suggest that staff reliance on force
exceeds many adult prison systems. It seems so pervasive that the overall
normative culture regimen becomes a rather hollow shell; a contradiction
quickly absorbed by the youth. Fred Cohen & Jane Haddad, Ohio
Department of Youth Services Consultative Report, (Aug. 3, 1998) 9
Some six years later in the Interim Report, I wrote, “We found the unwarranted
use of physical force and seclusion to be endemic to Scioto We [including Steve Martin]
found countless examples of situations where no force at all should have been used and
others where the force used was excessive.”
Thus, while we found essentially no change in this vitally important area over a
six-year period, ending in 2004, there is a glimmering of change accompanied by hope,
for example, at Scioto in 2007. While this is hardly cause for celebration, Scioto has at
least applied the brakes and begun to inch forward. For DYS as a whole however, the

The Report was prepared in response to the initiation of a CRIPA investigation by the U.S. Dept. of
Justice. The term “normative culture” refers to the DYS’s then in vogue treatment philosophy. It was
difficult to find any staff member who even knew what this treatment approach entailed.


unwarranted and excessive use of force along with questionable isolation/seclusion
practices remains of serious concern.
Director Stickrath has repeatedly communicated a DYS policy of zero-tolerance
of staff abuse toward the youth. New approaches to investigations of staff abuse are
being adopted; training in verbal techniques to manage disputes will soon be complete for
all staff; volunteers are beginning to saturate the various facilities bringing with them the
potential for reducing staff violence; supervision on the units is being streamlined; and a
new classification system may contribute to a reduction in violence.
This Report, of course, is constrained by what team members observed at a
particular point in time. While I credit the good faith commitment of Director Stickrath
to reverse the embedded “culture of violence,” I believe he would agree that there
remains “many miles to go.”
The November, 2004 Report also noted that we could find no integrated, overall
mental health plan; only a well rehearsed, verbal adherence to so-called “normative
culture,” the buzzword for a now abandoned treatment philosophy. While Scioto clearly
has made some progress in the area of a safe environment, neither DYS nor Scioto has
yet to develop and implement a cohesive, integrated, broadly understood overall
approach to treatment and rehabilitation. Scioto however, has at least begun to lay the
groundwork for a safe environment and, thereafter, possibly a more viable treatmentrehabilitation system.
A juvenile custodial system might well be safe yet have an ineffective treatmentrehabilitation program. However, it is inconceivable to even imagine an effective
program of treatment-rehabilitation where the youth are afraid; afraid of staff or afraid of
each other. At ORV we determined also that staff fear the youth.
Fear at ORV is an all-consuming fire, fueled by the three-dimensional aspects of
fear: youth fear other youth, youth fear staff, and staff fear youth. The team expert in use
of force, Steve Martin, writes in his individual report:
There are serious deficiencies in the administration of staff use of force at
ORVJCF. The deficiencies are so pervasive that youth protection from
harm by staff use of force is seriously compromised. Having reviewed
almost over 350 incident reports, numerous videos and investigations, in


addition to two days of on-site work, I believe there is evidence to support
a finding of a pattern and practice of unnecessary and excessive staff use
of force that can be placed in one of three categories of risks of harm to
a.) unsafe practices that are a product of untrained or ill-trained personnel
simply doing their best to manage troublesome youths, e.g., inappropriate
application of tactical holds causing injury.
b.) reckless practices in disregard of obvious risks of harm to youths, e.g.,
c.) malicious infliction of force on youths, e.g., use of hard impact fist
strikes. (Martin, ORV Report, p. 3)
This expert’s conclusions will come as no surprise to the DYS administration or
the staff at ORV. During the opening session of our September 13, 2007 site visit,
Superintendent Fred Nelson candidly told the Team of his concern with the level of
violence and property destruction.
He noted that general population youth have serious concerns for their personal
safety. Staff are on “stress leave.” Mr. Nelson indicated that he has even contacted the
State Patrol for help.
In my at times heated group interview with ORV’s JCO union representatives,
they all passionately agreed that they do not receive sufficient training on use of force.
With some minor variations, that complaint was raised in every group discussion I had
with union representatives from each facility we visited.
The variations included a complaint about a lack of clarity in the “rules of
engagement” themselves; that is, exactly when is it proper to use force and exactly what
physical restraint techniques are permitted under what circumstances. I will return to this
theme, infra.
Most union representatives adhere to the “just a few bad apples” explanation
when confronted with the observation that there is a pervasive culture of violence in
DYS. During my ORV, JCO session, I told the group that I believed they would not be
completely honest with me concerning use of force issues.


One officer plainly was offended by that remark and suggested I was being
somewhat arrogant. (That may not be the exact term used). I then slid my legal pad in the
officer’s direction and asked that the officer write the names of the “few bad apples” at
My invitation obviously went unaccepted. The “few bad apples” then, are
protected by a code of silence.
We talked more easily of group activities having been dropped as too dangerous
and the dangers of housing 13-year-olds with some 20-year-olds as “crazy.”
Expert Steve Martin went on to point out that of the six facilities investigated
ORV has the most dysfunctional system in place for controlling staff misuse of force.
Quoting again from Steve Martin’s ORV Report:
The use of force incident packets often don’t reflect whether incidents
have been reviewed, other packets have review forms that are totally
blank, and some packets contain two separate review forms, neither of
which was complete. The administrative review doesn’t include a viewing
of available video unless the incident is referred for investigation. Neither
the DSDS or the OA 10 could articulate a reliable set of criteria used to
conduct their reviews, nor was it clear when they refer an investigation to
the CIO.
In addition to a flawed administrative review system, the facility has failed
to utilize or employ a tracking system to monitor the status of the use of
force incidents they refer to local investigators. Recently, an administrator
temporarily assigned from another facility to assist in identifying
management deficiencies at the facility, found 88 incidents that had been
assigned to local investigators and had just “piled up” and had not been
completed. These investigations were forwarded to the CIO 11 where they
were reviewed to determine which incidents should be investigated locally
or by the CIO. The majority of those incidents have been returned for


DSDS is Deputy Superintendent of Direct Services; OA is Operations Administrator.
CIO is Chief Inspectors Office, a Central Office staff position.


local investigation. It is important to note that the number of use of force
investigations at ORVJCF is disproportionately high compared (both
local and CIO investigations) to the other DYS facilities. The
investigations that are completed at the local level are of a very
questionable quality, often resulting in facially unreliable findings.
Finally, employee sanctions are often inconsistent with the seriousness of
the use of force violation(s). (Martin, ORV Report at pp. 3-4)
With ORV, along with Marion and Indian River, in the top tier on the use of
force, restraints, and isolation, we find that of all the facilities that would benefit from a
sound system to control misuse of force, ORV may well be the least equipped to do so.
We are well aware of the administrative oversight implications inherent in this
analysis. We are also aware of a variety of efforts by Director Stickrath to resolve the
ORV dilemma. Our investigative task, however, is to describe and analyze what we find
at a given moment in time and for ORV we find a culture hostile to helping these youth
and unable or unwilling to properly investigate use of force.
Readers are referred to the Steve Martin, ORV Report of September 28, 2007, pp.
5-7 for his incident/investigation summaries. You will discover delayed investigations,
compromised investigations, and in Local Investigation 2007-136 March 23, 2007, where
a JCO was found to have hit a youth four to six times with a closed fist and the facility
Superintendent recommended removal from service. The State Collective Bargaining
Board held that the findings did not support removal. 12


In Ronald C. Wilson v. ODYS, Case No. 06-REM-04-0214 (Dec. 5, 2007), the Administrative Law Judge
upheld the decision of ODYS to remove appellant from his position as Operations Manager at Scioto.
Wilson was found to have escalated a volatile situation leading to the needless restraint of a youth. In
another incident, Wilson used a finger-flex hold on a youth, which resulted in this youth’s wrist being


Restraints & Isolation 13
The use of mechanical restraints and room isolation may fairly be dealt with in the
same general area as a “Safe Environment.” Physical force and mechanical restraints
never may be used for punishment while some forms of limited isolation are legally
acceptable as punishment in both the adult and juvenile systems. 14
In general we found that isolation is systematically used too frequently and for
much too long. Mechanical restraints, however, are rarely used except for two-point
restraints used to transport youth. At Scioto, for example, we could find no record or
evidence of the use of four-point restraints except a single instance where a girl asked to
be so restrained.
Based on their categorical vulnerability, juveniles have prevailed in court on
isolation and restraint claims where adults would not have. See Lollis v. N.Y. State Dept.
of Social Services, 322 F.Supp.473, 482, 484 (S.D.N.Y. 1970)(voiding the two-week
confinement of a 14-year old girl in a bare room with no recreation or reading material
and finding the use of shackles on a male juvenile in isolation for periods of time ranging
from 40 minutes to two hours impermissible). See also Nelson v. Heyne, 355 F.Supp.
451 (D. Ind. 1972)(discussing the right to treatment in conjunction with use of solitary
While I have elected to treat isolation and restraints as a question of safety, other
categorize this area as a constitutional deprivation of liberty. Relying on an assessment


Restraints refer to a device designed to interfere with the free movement of one’s arms and legs or which
totally immobilizes the person (for example, the four-point restraint) and which device must be modified or
discontinued by a third person.
Analytically, one may approach the use of mechanical restraints in three different circumstances: (1) pointto-point movement within a facility; (2) movement outside the perimeter of a facility, typically to another
destination (such as to the hospital, court, prison); and (3) immobilization within the facility.
Various forms of mechanical restraints — cuffs and leg irons are the most common — are used when
transporting certain inmates, during visits, or when simply moving about the facility.
The primary concern in this Report is with category (3), immobilization within the facility. See Cameron
v. Tomes, 990 F.2d 14 (1st Cir. 1993)(interestingly discussing the transport issue).
Isolation or seclusion in the DYS system does not he a precise meaning. In essence, seclusion involves
placing a youth alone in his or her own room or a so-called safe room for varying amounts of time.
Youths also may be placed in a highly restricted cell for as much as 23 hours a day, 7 days a week as part
of a Special Management Plan that appears to have no durational limit. This more nearly resembles the
penal isolation found in adult supermax prisons or segregations units.
See Fred Cohen, Isolation in Penal Setting: The Isolation-Restraint Paradigm, 22 Wash. U.J. of Law &
Policy 295, 306 et seq. (2006)(Based on testimony before the Commission on Safety & Abuse in Prisons).


conducted by the San Francisco-based, Youth Law Center, a recent OJJDP-ABA Report
Restraints/Isolation. Mechanical restraints and excessive isolation in
juvenile detention facilities stripped away the juveniles' liberty in violation
of constitutional due process requirements. The report commented that
"our experience in past litigation is that courts are not persuaded by the
excuse [that restraints and isolation become necessary because] the mental
health agency has not provided adequate services for, or removed from the
facility, emotionally disturbed youth." Furthermore, "an extensive body of
case law sets limits on the deprivations to which inmates may be subjected
in isolation" and provides due process rights for disciplinary hearings on
institutional rule infractions. (Patricia Puritz & Mary Ann Scali, Beyond
the Walls: Improving Conditions of Confinement For Youth in Custody 43
(ABA, 1998))
Whether approached as an issue of safety or in the more legalistic terms of
deprivation of liberty the use of mechanical restraints and physical isolation raise serious
questions. In addition to the universally-endorsed “never for punishment” injunction
several other principles should be articulated:
1. The factor of youth itself is a significant limitation on the use of isolation and
mechanical restraints. Thus, whatever the legal limitations in this area for adults,
juveniles have a right to even greater protection.
2. The frequency, duration, and rationale for the use of isolation and mechanical
restraints are reliable indicators of the extent to which a system, or individual
facility is more or less punitive more or less devoted to treatment or rehabilitation.
Expert Steve Martin, reporting on Scioto writes:
The use of isolation and seclusion is governed by at least three separate
SOP’s: Seclusion, 301.05.03; Special Management Plans, 305.01.01;
Youth Disciplinary Sanctions, 303.01.02. The Seclusion SOP identifies
four separate categories of seclusion: Extended Seclusion (more than
24hrs), Seclusion (less than 24hrs), Room Seclusion (less than 1hr), and
Safe-Room (no time limitations). The SOP for Youth Disciplinary


Sanctions provides for a period of seclusion up to 5 days. The SMP SOP
provides for seclusion without time limitations.
SJCF very frequently uses seclusion pursuant to all three SOP’s. The
“Seclusion Summary Report,” (“SS Report”) May 1 through June 30,
2007, reflects 267 seclusion intervention events totaling 3,485 hours. The
basic seclusion policy, 301.05.03, at Section IV.A.15., provides that
seclusion is not to be used “beyond 24 hours from the time seclusion was
implemented unless the youth behavior is a threat to the safety and
security of the institution and/or others.” However, pursuant to SMP’s,
the facility is imposing a pre-determined number of hours in seclusion for
acting out behaviors, see Incidents, ID 5502070733 & 5502070703, in
which one youth “was placed in seclusion for 12 hours per SMP and
another in which cursing behavior “warrants an 8 hour seclusion period.”
In discussing this issue with the DSDS it became apparent that the term
“seclusion” may be applied too broadly at the facility, or rather too
imprecisely, and may inflate the total number of hours reported. If for
instance, a youth is committed to a term of isolation pursuant to a
disciplinary hearing, should this event be reported/recorded as
“seclusion?” Further, if a youth is placed in “seclusion” for a
predetermined number of hours pursuant to a SMP, how should it be
reported/recorded? [Note: this is aside from the issue of whether such
predetermined lengths of stay are appropriate.] It may be that SJCF
officials rely too heavily on seclusion as a management practice; however,
until administrators, et al., determine exactly what constitutes “seclusion,”
and the proper basis for a placement decision, a truly qualitative analysis
is difficult to complete. On a final note regarding seclusion, a review of
the SSR reflects a small number of the same youths produce a large
number of seclusion interventions. This same pattern was also evident in
my review of use of force incident reports. (Martin, Scioto Report at
pp.12-13)(The incidents referenced in the text will be found in the full
Report attached to the Final Report)


Perhaps the most pernicious form of isolation relates to the Special Management
Plans (SMP).
With reference to Scioto mental health expert, Dr. Leta Smith examined the
mental health implications of SMP’s, noting:
[A]ccording to the 2006 SOP 301.05.03 concerning Seclusion, youth
placed in seclusion shall be checked visually by staff at least every 15
minutes and shall be visited at least once each day by personnel from
administrative, clinical, social work, religious, or medical unit. There is no
separate seclusion Mental Health policy, and youth are too frequently
placed on the POD as part of special management plans and for suicide
watch. The Adjustment Pod is teaching youth little to nothing, especially
when time and again Special Management Plans do not provide
meaningful opportunities to work toward defined goals related to
behaviors and/or to increase recovery. Plans are generally punitive and
very similar in structure for different circumstances and behaviors.
A review of SMPs for youth recently on the POD provided additional
clear confirmation that the plans are problematic. These youth are on the
mental health caseload and taking psychiatric medications. For all these
youth a visit by psychology was the very rare exception. Case #1 provided
for a 2-1/2 month plan rather than a plan extending time as necessary, and
with no provision for shortening the time. Although the plan called for
daily contact from one member of the treatment team professional staff to
minimize isolation and monitor mental health this was not the case. The
SMP for youth #2 and youth #3 also included ‘regular’ meetings with
clinical staff but these too were infrequent, and certainly far from daily.
Youth #2 and youth #3’s plan called for 8 additional hours of seclusion for
‘refusing direction.’ There are exceptions as youth #4’s plan is time
limited and provides graduated sanction, but again positive incentives are
virtually non-existent.
Staff need continued training and oversight on using these Special
Management Plans for behavioral improvement rather than punishment.


They should not routinely include the use of seclusion and need to be time
limited, individualized, with graduated punishments, incentives, and
carefully monitored and supported by clinical staff. (Dr. Leta Smith,
Scioto & Marion Site Visits July 31-Aug. 3, 2007, p. 6-7)(Again, the
youth plans that are referenced are discussed in some detail in the full
Report, which is attached.)
At ORV, as noted in Section II, I interviewed a 15-year-old youth confined to the
Intensive Program Unit (IPU). He had spent four months in this antiseptic, lock-down
unit that resembled the units and cells at the Ohio State Penitentiary, Ohio’s supermax.
The only difference is the cells at OSP had more furniture (a desk) and every cell has a
Level 1 (Red) involves a minimum two-week, 23-hours a day, 7-dyas a week
lockdown. Youth can, and often do, stay at this level well beyond the two weeks. Meals
are taken in the cell and out-of-cell movement seems limited to showers.
At Level 2, youth are out for one hour of daily recreation, meals are available on
the unit outside the cell.
Level 3 involves an hour at the gym, classroom attendance, and a bit more
There is only one social worker on the unit with 20 youth in confinement. There
is in practical effect, no treatment whatever. What goes by the name treatment team (a
JCO, unit manager, teacher, and social worker) is more like a unilaterally, functioning
classification team.
The youth is not present on the Monday’s when they meet nor is there any
psychiatrist. The Team makes the all-important level decisions and does not review
treatment plans or progress.
The youth I interviewed conceded that there are fights on the unit, especially at
Level 2 and mainly around showers or phone calls. He was surprisingly calm about his
situation; his desire to leave DYS and succeed. He was most disappointed at not getting
help with his problems and not being pushed with his education. He wanted to be
challenged intellectually and not just vegetate in a secure cell on a secure unit.


This youth believed he had an I.Q. of 160. Something I was unable to verify. He
had some hope in his eyes; he was articulate and, no doubt, hard to manage. The youth
had read all the Harry Potter books and wondered if I could get him some similar books
to read. I could only wonder how long that hope would survive, when would he simply
give up on a decent future and succumb.
The unit itself made an indelible impression with me as bringing to bear the worst
that adult corrections has — the supermax/secure segregation unit — to juveniles who
have been sent to DYS for treatment and rehabilitation.
This use of prolonged isolation under stark conditions, whether in the name of
treatment, management, or punishment must be dealt with in the resolution of this
litigation. The current practices simply cannot be sustained.

Incident Reports
With regard to Marion, expert Steve Martin reached the same conclusions as to
use of force as he found at ORV, finding a similar pattern and practice of unnecessary
and excessive staff use of force. Mr. Martin then examined use of force reporting and
after reviewing hundreds of recent Marion incident reports he concludes that staff
frequently submit reports that are incomplete and/or false.
Quoting Mr. Martin:
Moreover, there are incidents of force that are not reported at all. Reports
are often conclusory and lack sufficient detail to even determine the nature
of force used. Moreover, staff often use terms such as “fight break-up”
without fully describing what they actually did. The following
representative incidents provide examples of a badly flawed reporting
system at Marion Juvenile Correctional Facility.
Incident ID–4102070485, June 25, 2007: This is an incident in which a
JCO kicked a restrained youth in the head multiple times in plain view of
six staff members (based on my review of the video that captured the
entire incident). None of the JCO witnesses reported the kicks. A nurse in
attendance reported that the JCO’s “boot made contact with the left side of
the helmet the youth was wearing to prevent him banging his head.” The


single staff member who accurately reported the incident was the
Operations Manager (“OM”). The investigation of this incident did not
address any reporting issues. [Note: at the time of my site inspection, the
investigation had been completed sustaining the allegations against the
JCO who kicked the youth; however, she remained in a contact position
supervising youths at the facility. The Deputy Superintendent confirmed
that the facility is lacking a policy directive as to when staff are prohibited
from working in a contact position during the pendency of an investigation
of allegations of improper force.]
Incident ID–4102070455, June 16, 2007: This was an incident in which a
youth sustained “a possible separated shoulder” when “fight break-up”
tactics were used. Neither of the officer participant reports was
sufficiently detailed to allow any assessment of the cause of the injury to
the youth.
Incident ID–4102070449, June 14, 2007: This was an incident in which
one officer reported that a Unit Administrator (“UA”) used a “fight breakup” tactic on a youth. The UA reported that he used “Emergency Defense
& Basic Block” on the youth. The UOF policy defines Emergency
Defense as the “highest level of staff response that carries a substantial
risk that it shall proximately result in the serious physical harm or the
death of any person.” There is evidence to suggest that the UA simply
pushed the youth back into his cell; however, the incorrect use of terms in
the absence of detailed reporting simply creates serious ambiguity as to
what actually occurred.
Incident ID–4102070292, May 9, 2007: This was an incident in which a
youth sustained a dislocated shoulder. The two participant/witness
officers simply reported a “fight break-up” tactic that provided no
plausible explanation for the dislocated shoulder. A youth witness
reported a chokehold was used.
Incident ID–4102070487, June 25, 2007: This was an incident in which a
youth reported that he was choked by an officer. A medical exam noted


that his “tonsils [were] enlarged.” The video established that the officer
did indeed “wrap his left arm around the neck area” of the youth. The
officer had failed to submit any report of this incident. (Martin, Marion
Report at pp. 5-6)
Some of the more egregious use of force situations at Marion involved
supervisors directly and improperly participating in the application of force. This
practice is objectionable even where the force might be needed and properly applied.
The two disturbing incidents that follow are somewhat more aggravated than others
reviewed but are nonetheless instructive:
Incident ID–6020342, April 11, 2006: This was an incident in which
officers intervened in a fight between two youths in a classroom. As the
two youths were escorted through the hallway around other non-involved
youths, one of the non-involved youths exchanged words with an OAM
(one of the supervisors should have secured the hallway prior to the escort
of the two youths from the area). As the youth was walking away with
his back to the OAM, rather than continue to supervise the dispersal of
other youths in this potentially volatile situation, the OAM suddenly
attacked the youth with a chokehold and took him to the ground.
Notwithstanding this gratuitous assault on the youth, compounded by his
failure to report the incident and his false statements during the course of
the investigation, the disciplinary sanction imposed was a 3-day
suspension. [Note: one of the youths involved in the fight had earlier been
taken down in the hallway with a chokehold in which a very large officer
remained on top of the youth until the youth experienced a loss of
consciousness. When the OAM arrived upon this scene, he immediately
became directly involved in the restraint of the now motionless youth.
The medical report indicated the youth had sustained multiple head
injuries, was “sluggish to reaction” and was “profusely diaphoretic.” ]
Incident ID–4102070363, May 26, 2007: This incident involved a youth
with an extensive history of mental health problems who was observed
threatening to engage in self-harm with a piece of plastic from a scrub


brush. After complying with orders to relinquish the piece of plastic, the
youth was cuffed and an UA arrived on the scene to direct his movement
to a safe room. The UA was accompanied by multiple staff, including no
less than four officers. A decision was made to strip the youth 15 and place
him in a suicide smock. Rather than supervise staff, the UA took the
diminutive youth to the floor and straddled him with her considerable
body weight. Thus began an excruciatingly long application of force in
which the UA continued her direct involvement and failed to prevent other
staff from repeatedly engaging in tactics that created extreme risks of
harm to the youth. In reviewing the video of this incident, I observed
multiple instances in which the youth was placed in positions commonly
associated with in-custody deaths from positional asphyxia. In a
remarkable display of reckless force tactics, one officer attempted to place
the suicide smock on the youth’s head as a make shift spit-mask (see
Incident ID-4102070448, in which a shirt was used on a cuffed youth as a
make shift spit-mask). In another instance, an officer can be seen with his
full body weight on the youth’s back with his knee across the youth’s
neck. The decision was then made to place the youth in 2-point restraints.
Notwithstanding that the youth was cooperating with staff and even trying
to assist them in securing the restraints, they were unable to secure the
restraints in a proper and timely fashion. [Note: In my considerable
experience reviewing use of force videos, I have rarely viewed an incident
that more graphically exemplifies the reckless risk of harm that may be
visited on a subject by ill-trained personnel. It is not idle conjecture to
suggest this youth could have been fatally injured. Finally, while I have
not conducted a full analysis of this event, I believe it is questionable as to
whether the initial use of force that precipitated the protracted application
of force was even necessary.] (Martin, Marion Report at pp. 7-8)


Several youths in the group this writer interviewed reported that JCO’s “rip off our clothes and throw us
in our rooms.” How common this might be and under what circumstances is not known.


Having viewed the same video I will state in even stronger terms, there was no
need for the application of any force. The frail youth was standing alone in a safe cell,
subdued, and no immediate danger to himself or anyone else. Staff had only to remain at
the open door, observe the youth, and he would eventually have disclosed the implement
he used to scratch/cut his arms.
Beyond this critique on use of force is the total absence of a clinical presence or
response to this incident involving a seriously mentally ill youth. DYS staff view the
“cutting” as open to a disciplinary charge of “creating an institutional hazard.” (The
youth’s blood, I am told, might create an infectious disease potential.)
Surely this is an event (cutting) in which to intervene and to provide needed
medical care for these superficial wounds. Just as surely this is a mental health event
calling for a clinical presence and involvement in de-escalation tactics and then
supportive therapy. We, in turn, are constrained to report the event in its crudest, most
primitive terms: unnecessary and life-threatening, use of force plus the involvement of a
The administrative reporting and review process here also is flawed beginning
with often deficient reports and an absence of identified criteria by which to conduct
reviews. There is no routine examination of video evidence.
The use of seclusion and isolation at Marion illustrates some important systemwide issues. Marion makes frequent use of seclusion. However, the Seclusion Summary
Reports do not include isolation imposed pursuant to the youth disciplinary system;
youths placed on the IPU (this includes the “23/7” room or cell confinement for the first
two weeks); and the “lockdown” of youth who are disruptive at school.
The Marion Seclusion Summary Report for May 1 – June 30, 2007 identifies 268
seclusion events, with 25% of these involving just three youth. All three also are overrepresented in use of force incidents and have histories of mental health problems. 16
Our findings on use of force at Indian River regrettably mirror those for ORV and
Marion. To quote directly from expert Steve Martin:
There are serious deficiencies in the administration of staff use of force at
IRJCF. The deficiencies are so pervasive that youth protection from harm

We uncovered no significant problems in the use of mechanical restraints at Marion.


by staff use of force is seriously compromised. Having reviewed almost
500 incident reports, numerous videos and investigations, in addition to
two days of on-site work, I believe there is evidence to support a finding
of a pattern and practice of unnecessary and excessive staff use of force. . .
The patterns and practices seen at IRJCF are not unlike those seen at
virtually all the facilities subject to our inspection. While there are
certainly differences and variances in the magnitude of particular
deficiencies at IRJCF vis-a-vis other facilities, the cumulative deficiencies
across all issues subject to my review result in the same findings of
pervasive risks of harm to the youths confined at IRJCF.
Use of force reports are often lacking in detail, contain conclusory
statements, and in some cases, are not even filed by all participants or
witnesses. Supervisors are too often applying force rather than
managing/overseeing an incident. Administrative reviews are not
systematically conducted to include video reviews nor is identifiable
criteria consistently applied in making investigative referrals.
Investigations are generally of a poor quality and are not conducted with
the degree of impartiality necessary to yield reliable findings. Finally,
employee disciplinary sanctions are often too lenient, reduced in their
severity without a sound evidentiary basis, or not imposed at all. (Martin,
Indian River Report at pp. 3-4)
Readers are advised to consult the representative five summaries of incidents and
investigations contained in the aforementioned Martin Report. You will discover false
and misleading statements by staff; dubious, if not simply unbelievable investigations and
reports, avoidable physical injuries inflicted on youth; and staff actions and reactions that
either initiated or accelerated a confrontational situation.
For the May-July period, there were 818 intervention events at Indian River
totaling 26, 204 hours as compared to Mohican that totaled 2,874 hours for the same time
period. Indian River had 143 youths who each spent 72 or more hours in seclusion
totaling 17,271 hours as compared to Mohican who placed four youths in seclusion for
more than 72 hours each totaling 383 hours. A large number of the seclusion hours for


this time period can be attributed to a program initiated by the superintendent in May
2007 intended to reduce/manage high levels of violence and disruption occurring at the
Youths who were engaging in disruptive conduct were isolated on one particular
unit and single celled for program participation similar to the questionable Intensive
Programming Units at the Marion and Ohio River Valley facilities. While the program
reduced the violence in the general population, it increased significantly on the unit to
which the disruptive youths were housed. The superintendent abandoned the program in
August due to her concerns over the number of youths being held in virtual “lock-up” on
the unit.
Even discounting the seclusion hours attributed to Operation Fresh Start, Indian
River seclusion hours remain high. Steve Martin’s review of incident reports for the
period showed that seclusion is often used for punishment without utilizing the formal
youth disciplinary sanction process.
When a youth is given seclusion time pursuant to the disciplinary process, he may
appeal the sanction which cannot be served until the appeal is resolved by central office.
It can often be weeks until the appeal is processed; thus, the youth serves the time far
removed from the violation itself. Facility officials understandably believe that the
punitive value of seclusion is undermined for two reasons. First, such punishment is
most effective if it is imposed close in time to the violation. Second, if the youth has
made positive adjustment since the violation, to place him in punitive seclusion weeks
after the event can undermine his now positive adjustment.
In Steve Martin’s discussions with the OA on the Seclusion Summary Report it
became apparent that it needs to be audited both by facility and central office officials.
For instance, some facilities include disciplinary seclusion on the Seclusion Summary
Report but Indian River doesn’t. Indian River’s report was replete with entries in which
“Room Seclusion” exceeded the one-hour time limit imposed by the seclusion policy yet
no official had questioned these apparent violations of policy. The Seclusion Summary
Report provides extremely valuable information to both facility and central office
officials in terms of oversight; however, it simply is not being utilized at either level to
monitor this issue throughout the system.


Finally, it should be noted that the vast majority of youths placed in seclusion at
Indian River are placed in their assigned room. When a youth is placed in seclusion in a
double cell situation, during the waking hours the bedding for both youths is removed
which penalizes the non-involved youth. Each housing hallway has a wet cell that is
used when a youth is given seclusion pursuant to a disciplinary hearing.
With regard to the Circleville and Mohican facilities we found that while there
were isolated instances of questionable use of force there is no pattern or practice of harm
inflicted on youth confined there.
At Circleville, for July-August 2007, there were 30 interventions with any kind of
physical force, the lowest total for all six facilities visited. By way of contrast, Marion’s
totals for a recent two-month period were 272.
Mohican was determined to be the facility where the review process most often
resulted in predictable and systematic referrals for investigation. Mohican also strictly
follows the review process required by the SOP on point whereas Marion and Indian
River do not appear to use the appropriate form.
This, of course, suggests a flaw in the Central Office oversight/auditing of the
administrative review process.
Interestingly, where the review of use of force is faithfully and systematically
done, we also find no serious pattern or practice of either unnecessary or excessive use of
Circleville uses seclusion less frequently and for briefer periods than the other
five facilities visited. Over 91% of the seclusion events are for less than eight hours in
duration with 70% less than four hours.
Over a recent, three-month period, only five events resulted in seclusion for over
36 hours and the incident reports show that serious misbehavior precipitated the event.
Mohican, on the other hand, makes more frequent use of isolation, although 76%
are for zero-four hours in duration. By way of contrast, Indian River averaged 32 hours,
Scioto 13 hours, and Marion eight hours. Even so, the Superintendent at Mohican
developed a survey instrument to determine whether youth seek seclusion to be alone and
to determine if a designated area versus a locked room might be a more appropriate


Four-point restraints at Mohican and Circleville appear to be rarely applied.
Mohican rarely uses any kind of restraints and when applied, they are used in conjunction
with a Special Management Plan.
As a general proposition, where isolation and seclusion raise significant questions
and present challenges for reform, the DYS system does not appear to make excessive,
inappropriate or harmful use of mechanical restraints.
It is important, however, that training continue in this area emphasizing when and
how to use two- and four-point restrains and the special procedural and monitoring issues
related to immobilizing youth with mental illness.

Select Use Of Force Incidents
Enclosed with this Report is a DVD that contains several select” use of force”
incidents that were witnessed by team member Steve Martin. What follows is a narrative
to accompany and enhance your understanding of the events portrayed on the DVD.
We request that the court keep the DVD under seal and that counsel not disclose
the DVD in order to protect the privacy of the youth.

1). Scioto Incident, March 9, 2007: This incident involved a female youth who
had recently engaged in self-injurious behavior (inflicting wounds with paper
clips/writing instruments). She pushed past staff to get out of her room on the Buckeye
Unit. A JCO employed a chokehold as a takedown technique. Immediately after the
takedown two staff members can be seen recklessly yanking and pulling on the youth’s
legs. The JCO continued to place his body weight on the youth while continuing the
chokehold. In the presence of an OM, the JCO was allowed to continue this dangerous
position for an extended period of time, actually hindering the application of restraints,
and causing the youth to repeatedly scream and hysterically plea to be released from the
chokehold. None of the incident reports referenced the chokehold. Various reports
described her as “very combative” after the takedown when in fact she was likely
struggling as a result of air hunger or suffocation panic. This incident was not referred
for any follow-up inquiry or investigation. There is no evidence that the video was ever
reviewed in concert with the incident packet.


2. Marion Incident, May 26, 2007: This incident involved a youth with an
extensive history of mental health problems who was observed threatening to engage in
self-harm with a piece of plastic from a scrub brush. After complying with orders to
relinquish the piece of plastic, the youth was cuffed and an UA arrived on the scene to
direct his movement to a safe room. The UA was accompanied by multiple staff,
including no less than four officers. A decision was made to strip the youth and place
him in a suicide smock. Rather than supervise staff, the UA took the diminutive youth to
the floor and straddled him with her considerable body weight. Thus began an
excruciatingly long application of force in which the UA continued her direct
involvement and failed to prevent other staff from repeatedly engaging in tactics that
created extreme risks of harm to the youth.
In viewing this video it should be noted that there were multiple instances in
which the youth was placed in positions commonly associated with in-custody deaths
from positional asphyxia. He remained in a face-down prone position much too long. In
a remarkable display of reckless force tactics, one officer attempted to place the suicide
smock on the youth’s head as a make shift spit-mask which clearly impaired his air
passage ways. An officer can be seen with his full body weight on the youth’s back with
his knee across the youth’s neck with the suicide smock over his airways. The youth
actually screams that he can’t breathe.
The decision was then made to place the youth in 2-point restraints.
Notwithstanding that the youth was cooperating with staff and even trying to assist them
in securing the restraints, they were unable to secure the restraints in a proper and timely
fashion. It should be noted that 2-point wrist-to-wrist restraints (ambulatory restraints)
are designed for the wrists to be cuffed to the side-front of the body. In the video, it is
clear that officers are attempting to cuff in the side-back with his arms turned backwards
greatly increasing the risk of fractures to his arms/shoulders. After abandoning the first
set of restraints, the officers persist in cuffing the youth in the same dangerous fashion. It
should also be noted that the extraordinary length of time to make either set of restraints
available greatly increased the risks of harm to both the youth and staff.
3. Marion Incident, June 25, 2007: This is an incident in which a JCO can be seen
kicking the fully restrained youth in the head multiple times in plain view of six staff


members. After the JCO had been physically pulled away from assaulting the youth, all
staff then exited the room leaving the youth alone with the offending JCO. The JCO
remained in the room alone with the youth for at least ten minutes.
None of the JCO witnesses later reported the kicks. A nurse in attendance
reported that the JCO’s “boot made contact with the left side of the helmet the youth was
wearing to prevent him banging his head.” The single staff member who accurately
reported the incident was the Operations Manager (“OM”). The investigation of this
incident did not address any reporting issues. [Note: at the time of my site inspection, the
investigation had been completed sustaining the allegations against the JCO who kicked
the youth; however, she remained in a contact position supervising youths at the facility.
The Deputy Superintendent confirmed that the facility is lacking a policy directive as to
when staff are prohibited from working in a contact position during the pendency of an
investigation of allegations of improper force.]



Dr. Leta Smith in beginning her Summary Report of Initial Site Visits 1 (October
7, 2007) states, “Overall the provision of mental health care and treatment throughout
ODYS is fundamentally deficient and structurally inadequate in design and function.”
Apart from the often heroic efforts of isolated mental health care providers — certainly
including Dr. Julie Neidermeyer — we could find no strength upon which to comment or
build. There has been a flurry of corrective plans and some action in this area, at least at
Scioto and Marion, but it came after our field investigation and too late to materially
influence our general observations.
In our Interim Report of 2004 at pp. 27-31 we found that there were virtually no
proactive mental health services; individualized treatment plans were lacking, along with
proper documentation and a continuum of care. There was no mental health unit, except
in name.
Scioto, at best, provided crisis care and yet the then Clinical Services Director,
believed that mental health care was good. The then Director of DYS asked me to
prepare a “Mental Health Program” for reforming mental health care, which I did. (See
Appendix E). That program was never even commented upon by any DYS official.
There are a number of initiatives in place, described in an Addendum to this Section but
we were unable to detect a measurable impact during the course of this investigation.
Kathy Burns, M.D., a highly regarded forensic psychiatrist, was asked to visit
only Scioto and Marion. Dr. Burns found that the very basics of fundamental mental
health are lacking. This echoes Dr. Smith’s finding, it echoes the findings in the Interim
Report, and it echoes my individual conclusions based on our current investigation. The
DYS officials in charge of mental health and rehabilitation cannot claim ignorance. I
have been sounding the alarm now for about 10 years.
Please note that this investigation and Report does not confront mental health and
rehabilitative care at the level of a debate e.g., on treatment modalities, efficacy studies,
bed utilization studies, the formulary, and so on. Those are matters to be dealt with in the
context of even a dimly outlined system of care, a system we find lacking.


The overall mental health caseload is roughly 25% to 35% of all DYS youth and
that is low compared with other states and the available incidence data
In constructing a Model for dealing with the identification and treatment of youth
involved with the juvenile justice system, Skowyra and Cocozza conducted the most
comprehensive study to date: 1,437 youth in three different states in three different types
of juvenile justice settings detention, corrections, and community-based programs.
The results of the study, which were incorporated into the Model, confirmed that,
regardless of level of care or geographic region of the country, the majority of youth in
the juvenile justice system meet criteria for at least one mental health diagnosis. Overall,
70.4% of youth were diagnosed with at least one mental health disorder, with girls
experiencing a higher rate of disorders (81%) when compared to males (66.8%). For
many of the youth in the study, their mental health status was complicated by the
presence of more than one disorder. Of those youth who were diagnosed with a mental
health disorder, 79.1% met the criteria for at least one other mental health diagnosis. The
majority of youth who met criteria for a mental health diagnosis were also diagnosed with
a co-occurring substance use disorder. Among those youth with at least one mental
health diagnosis, approximately 60% also met criteria for a substance use disorder. 17
There is a stunning difference between this latest study and the Ohio caseload
even allowing for the contingency that caseload figures may not completely reflect
diagnostic and off-caseload care. It is not hyperbole to state that the Ohio DYS, like all
similar state agencies, is a proxy mental health agency. That being said, the need for
fundamental change is — and has been — painfully obvious.
To the extent that one accepts significant system-wide underdiagnosis and
treatment, the consequences are broad and severe. Delayed treatment means needless
suffering and preventable deterioration, the essence of Cruel and Unusual Punishment;
self-harm and harm to others; inappropriate and harmful punishment for acting out
behavior driven by mental illness; needless isolation and its multiple, harmful
consequences; and, too often, the enhancement of self-loathing linked to self-destructive

Kathleen R. Skowyra & Joseph J. Cocozza, Blueprint for Change: A comprehensive Model for the
Identification and Treatment of Youth with Mental Health Needs in Contact with the Juvenile Justice
System, p.IX (National Center for Mental Health & Juvenile Justice, 2007).


Whether a class member’s right to treatment and rehabilitation is framed in terms
of Due Process or Cruel and Unusual Punishment, our findings on the inadequacy of the
system and the consequent harm will meet either a denial of a Due Process liberty interest
or deliberate indifference to a serious mental disorder.
Alexander S. v. Boyd, 876 F.Supp. 773, 796 (D.S.C. 1995), is perhaps the most
recent significant affirmative federal decision on behalf of juveniles’ rights to various
forms of care. The court specifically looked to the purpose of the juvenile court and
found that Youngberg v. Romeo, 457 U.S. 307 (1983), required that children receive
training that provides them with a reasonable opportunity to accomplish the purpose of
their confinement, to protect the safety of the juveniles and the staff, and to ensure the
safety of the community once the juveniles are ultimately released.
Alexander S. determined that minimally adequate programs and services are
constitutionally required and are to be designed to teach juveniles the basic principles that
are essential to correcting their conduct. These generally recognized principles include:
(1) taking responsibility for the consequences of their actions; (2) learning appropriate
ways of responding to others (coping skills); (3) learning to manage their anger; and (4)
developing a positive sense of accomplishment. ODYS officials indicate an existing
commitment to these principles.
This ruling is interesting for two other reasons. First, unlike the court in
Youngberg, the Alexander S. court envisioned training or treatment in relation to the
outside world, not solely in relation to life inside the institution. Second, in no right to
treatment case with which I am familiar before Alexander S. did a judge articulate the
purpose of treatment. While there is frequent talk about the need for treatment or
rehabilitation, and many authorities set forth the techniques by which it should be done,
none grapple with the elusive, qualitative goals of treatment and none clearly defines
rehabilitation or attempts to distinguish treatment from rehabilitation.
Alexander S., then confirmed a right to treatment on behalf of the juveniles in the
custody of the South Carolina Department of Juvenile Justice and perhaps unwittingly did
so in a fashion that enlarged the disease-oriented concept of treatment to include the
broader concept of rehabilitation.


Judge Alexander did link South Carolina’s statutory commitment to rehabilitation
— much like Ohio’s — to the constitutional duties he articulated. See Alexander S., 875
F.Supp. at 795-800 for a discussion of applicable constitutional standards, settling on the
Due Process Clause.
Miller v. Natalucci-Persichetti, 1992 WL 1258522 (S.D. Ohio) concluded that a
juvenile who is committed to a correctional, as opposed to a mental health institution, has
a right to treatment under the Fourteenth Amendment. Judge Rice focused on Ohio law
and the absence of procedural safeguards which parallel those in a criminal proceeding.
The court appeared to accept the fact that the juvenile involved in this case, and who
committed suicide in a juvenile facility, had severe emotional problems. Thus, this is not
a decision finding a broad-based right to treatment; only the relatively easy finding that
involuntary custody in a government facility requires treatment of serious illnesses.
It is my view of the law on point that all juveniles who are involuntarily confined
have at least the same right to mental health treatment as pretrial detainees and prison
inmates. Indeed, I feel certain that is the current state of the law. What is it that the
hedge-term “at least” may encompass?
Simply , being young — an adolescent — should be a powerful factor in
determining the precise application of due process to a juvenile’s claim to adequate
mental health care for serious mental health needs. Deliberate indifference, if that is to
be the test, should be informed by the knowledge we now have concerning adolescent
cognitive, intellectual, emotional, social, and moral development.
The general acceptance of a need for early detection and intervention and of a
very high incidence of emotional and mental disorders among youth in official custody
should become benchmarks for the duty of care evaluated as a part of deliberate
indifference analysis. Early detection means one thing for an adult; for a young person it
includes early in life as well as early in onset.
What follows is a slightly redacted version of the Report prepared by Dr. Kathy
Burns after her site visits to Scioto and Marion. 18 DYS’s problems begin at the front
door during reception at Scioto and then pervade the entire system; understaffed, lacking

Dr. Burns’ September 27, 2007 Report is so comprehensive and yet succinct that I see no point in
paraphrasing from it. This Report, then, will not also appear in the Appendix since the redaction relates
only to procedural-type matters.


coherence and direction, lacking leadership, lacking the rudiments of legally mandated
mental health care and basic rehabilitation efforts.

Scioto & Marion Report: Kathryn A. Burns, MD, MPH, 9/27/2007
Scioto Juvenile Correctional Facility
Scioto Juvenile Correctional Facility serves as the reception center
for both males and females entering ODYS. Boys stay at the facility for
the reception and classification process and are transferred out to their
assigned institutions within 30 days. There are approximately 200 boys at
Scioto at any given time. Scioto is the only ODYS facility for girls. It
serves as both reception center and parent institution for girls. There are
approximately 90 girls at Scioto. The mental health program consists of
reception screening and assessment for both boys and girls and outpatient,
including crisis intervention, and residential treatment for girls. The
residential treatment unit for girls at Scioto is analogous to the Intensive
Mental Health Unit at Marion for boys.
Mental Health Services for Boys at Scioto: Reception Screening &
When boys arrive at Scioto, they are seen within the first hour of
arrival by medical nurses who screen for physical health issues, immediate
mental health needs and psychotropic medication history. Two medical
nurses are assigned to the reception process for boys. They are located in
a small office/examination room inside the building that is used for
reception. Medical nurses refer to the psychiatrist(s) based upon a youth’s
current or past psychotropic medication history. Currently prescribed
medications are discussed with the psychiatrist on site and ordered by the
medical nurses to prevent any lapses in medication. Non-emergency
referrals are scheduled to be seen by the psychiatrist within a few days of
arrival. Emergency referrals for mental health are seen by the psychology
staff assigned to reception. (Depending on the nature of the crisis, if a


psychiatrist is on site at the facility, he or she will see the emergency
referrals in the reception area or can be contacted via telephone to provide
consultation and medication orders as necessary.)
Psychology staff assigned to reception score the arriving youths’
MAYSI-2, review the documentation accompanying the boys and conduct
individual standardized interviews with each boy within the first two
weeks of arrival. No further psychological or psychometric testing is
routinely conducted; some intelligence testing is completed in rare
instances. The purpose of the psychological assessment appears to be to
arrive at an appropriate housing disposition and institutional classification
and not for mental health treatment. Psychology staff in this area rarely
make recommendations for treatment beyond placement on a watch or
expedited transfer to an “intensive” or “non-intensive” mental health unit
believing that their role is simply to compile information for eventual
treatment providers further downstream as the boys are shipped out to
their permanent/parent institution within 30 days. In fact, one Ph.D. level
psychology assistant who has been working in reception for several
months (and was at the institution previously as well) said she did not
even know how to make a referral to psychiatry, assuming that if it was
needed, the medical nurses would already have done so. Mental health
staffing levels do not allow for the provision of treatment during the
reception phase except for psychotropic medication, psychiatric
assessment/follow-up and crisis intervention as needed.
Mental Health Staffing
At the time of the August site visit, mental health staffing levels
consisted of one licensed psychologist and three psychological assistants
for boys’ reception in addition to some adult psychiatry contract hours.
As previously noted, this level of staffing provided for boys’ reception
permits nothing in the way of treatment beyond on-going prescription of
psychotropic medication and expedited transfer to another facility if
additional care is needed.


Mental health services for girls (reception, general outpatient,
crisis intervention and residential treatment) are provided by one full time
psychologist and one 25 hours per week psychologist, two psychology
assistants, 2 licensed (but not independently licensed) social workers, one
psychiatric nurse and some psychiatric hours provided by adult
psychiatrists on contract from Ohio State University (OSU.) As in the
case with services for boys at Scioto, girls’ mental health services are
profoundly understaffed given the prevalence and severity of mental
disorders present in the population as well as the diversity of missions at
the facility (reception, classification, multiple security levels in the same
institution, education, outpatient mental health care, crisis intervention,
residential mental health care, medical operations, etc.) in addition to there
being no access to an inpatient level of psychiatric care for girls so that
even the most acute conditions are managed on-site! The lone psychiatric
nurse serves as a liaison from all areas of the institution to the contract
psychiatrists and assures that boys and girls are scheduled to be seen by
the psychiatrists in a timely manner, that they receive prescribed
psychotropic medications as ordered and without lapses and that all
psychiatric orders are implemented. There is little to no time whatsoever
available to do any sort of medication education or other psychiatric
nursing intervention. Further, the psychiatric nurse serves many clerical
functions in that there are no clerical positions for the mental health
program at Scioto.
There are approximately 34 hours per week of psychiatric time at
Scioto split among boys’ reception (approximately 20 hours), girls’
outpatient and residential mental health treatment unit. Three psychiatrists
provide these hours – none of them are Child and Adolescent Psychiatrists
(CAP). When queried about whether or not this was believed to be a
problem, the “chief” or “main” OSU/ODYS psychiatrist said that most of
the kids were older adolescents/young adults rather than children and so
didn’t consider the lack of CAP training to be a problem. While


chronologically, I cannot argue with her rationale, I strongly believe that
these kids are psychologically and emotionally quite immature and that at
least some psychiatric time or consultation by a CAP is extremely and
urgently important.
Psychological and social services staffing levels for girls do not
permit regular, individual (or group) on-going focused therapy because of
the frequency and urgency of crisis interventions and multiple daily
mental health watch risk assessments. At least one girl at Scioto had been
on a 1:1 watch every day, 24-hours per day, continuously for more than
two months at the time of the August site visit. Others had been on and
off watches for shorter, but still extraordinarily long periods of time.
Girls’ Residential Mental Health Unit (Special Needs Unit)
The girls’ Special Needs Unit at Scioto is a 14 bed residential
housing unit for severely mentally ill girls. It also contains an additional
approximately 5 rooms behind a walled off area of the unit where mental
health watches can be conducted in an area that is near, yet apart from and
quieter than the rest of the unit. As with the boys’ Intensive Mental
Health Unit, the admission, discharge and continued stay criteria for the
girls’ Special Needs Unit are unclear in existing DYS policy and
procedures. None of these decisions appear to be functions of the
psychiatrists, although their input is considered. Similarly, programming
and treatment expectations are non-specific. However, most of the girls
housed on the unit appeared at the time of the site visit did appear to suffer
from significant mental health problems which included a high prevalence
of self-injurious and suicidal behavior.
Staffing levels to manage a unit of this size and acuity were
woefully inadequate. There was essentially no mental health group
programming. Social workers conducted some groups although these
have not historically been considered mental health interventions; they are
not documented in the mental health file nor necessarily part of the mental
health treatment plan which is developed by psychology staff independent


of other disciplines. Individual mental health interventions are primarily
crisis interventions. There is little or no time for routine, regular, on-going
focused psychotherapy. Mental health care is essentially “on demand”
through verbalizing intent to harm oneself or actually engaging in selfinjurious behavior. Although there was some training for staff on the use
of Dialectical Behavioral Therapy (DBT) several years ago, it is not
utilized for reasons that are not clear given the population at Scioto and
DBT’s demonstrated efficacy in the treatment of borderline personality
characteristics including self-injury.
Girls in the mental health unit and in the watch area can be placed
on some level of individual observation for periods of days, weeks or even
months, without a clear behavioral or other plan to intensify or otherwise
modify treatment interventions to get them off watch and back into routine
activities. This continues to reinforce the notion that the way to get
attention is to threaten or actually harm oneself because staff have no time
to see anyone else. It further diverts already scarce staff resources away
from on-going, regular and perhaps prophylactic treatment of others.
Mental Health Treatment
At the time of the site visit, 47 girls (approximately 50% of the
female population) and 26 boys (13%) were prescribed psychotropic
medications. These prevalence rates are substantially lower than we
expected and as reported in some other prevalence studies conducted in
juvenile correctional populations. The screening and referral processes
both at the time of reception and thereafter raise enough questions to call
for closer scrutiny during the remediation phase of S.H.
Boys in reception receive little mental health treatment beyond
psychotropic medication and individual psychiatric follow-up
appointments. Psychological staff conduct a type of reception assessment
but it appears to be aimed at arriving at an appropriate classification and


placement decision rather than designed for assessing (and then
addressing) mental health treatment needs.
As was the case for boys on the mental health caseload at Marion,
the girls on the mental health caseload receive parallel rather than
integrated care by the various staff involved. Mental health treatment
plans, if present, are developed unilaterally by psychology staff without
ever having treatment team meetings. There are three other types of
meetings at Scioto during which mental health information is discussed,
but none of them are actual mental health treatment team/treatment
planning meetings. There are “Psychiatry Team Meetings” conducted
weekly in which one psychiatrist and psychology staff meet to discuss
girls prescribed psychotropic medications. These meetings are not
documented and the patient does not attend. There are “Clinical Team
Meetings” during which psychology staff, the unit manager and social
worker meet to discuss the mental health caseload. These are not
documented and neither the psychiatrist nor the patient attends. There are
“Interdisciplinary Team Meetings” that are meetings of psychology staff,
unit staff, social workers, juvenile correctional officers, educational and
recreational staff during which individual girls are discussed and also
invited to participate. The psychiatrist is not included. These meetings
are documented – but not in the mental health file. Subsequently, it is not
a surprise that mental health interventions are parallel rather than
integrated and this is reflected in the documentation plan: psychiatric
assessments, follow-up notes and medication information are contained in
the youth’s medical file while psychology notes are contained in the
“Psychological File.” Psychological files are maintained in the psychology
staff offices and are not provided to the psychiatrist when he or she is
seeing cases. Each youth also has a social services file which could
contain additional mental health information. Additionally, psychology
notes and social service notes are in the process of being entered into
Microsoft Access Databases. At the present time therefore, there are three


paper files and two electronic files containing mental health information
for each youth. Due to the ODYS interpretation of confidentiality rules
and protected health information, not all disciplines have access to all of
these multiple files at the present time.
As previously mentioned, psychological interventions are
frequently limited to crisis interventions due to the paucity of staff
available to provide any on-going type of treatment as well as the acuity
level of the girls on the Special Needs Unit. Essentially no psychological
testing for diagnostic clarification, assessment or any other use of
standardized, objective instruments to monitor response to treatment are
utilized. Mental health staff at Scioto are looking forward to the adoption
of a trauma-informed care treatment model department-wide as planned
by Central Office Mental Health administrative staff. Presently,
essentially all mental health treatment provided is via individual sessions
with the psychiatrist or a psychologist; there is no group treatment and
there is no unifying model of psychotherapeutic intervention at the
The psychotropic medication formulary is unrestricted and all
classes of medications are available. The frequency of psychiatric followup is approximately monthly, more frequently in reception given the short
stays there. The psychiatrists work with the lone psychiatric nurse and are
able to schedule youths more frequently than monthly based upon clinical
need. Laboratory studies and monitoring for potential physical health
complications from the use of psychotropic medications are appropriate
and timely. The psychiatrists generally obtain verbal informed consent
from a parent or guardian via telephone discussion when a child is under
age 18. This is documented in the medical paper file. Informed consent
documents are also mailed to parents for signature and return. As was the
case at Marion, prescription of stimulant medications for treatment of
ADHD was extremely conservative, substituting use of Clonidine, atypical
antipsychotics and mood stabilizing medications.


Access to psychiatric inpatient care is not available unless a youth
is 18 years old and can be hospitalized in an adult state psychiatric
hospital. This is a grave and unacceptably dangerous situation.

Marion Juvenile Correctional Facility
Marion Juvenile Correctional Facility is one of two “close
security” facilities operated by ODYS and houses only adolescent boys.
Close security is the highest security level in the ODYS system. The
average daily population at Marion is approximately 275. Most residents
at the facility are transferred from the reception process at Scioto Juvenile
Correctional Facility although some transfer in from other lower security
facilities as a consequence of behaviors leading to an increase is security
The mental health program at Marion consists of outpatient
services, including crisis intervention services and an “Intensive” Mental
Health Unit. The intensive mental health unit is a 12 bed residential unit
to house boys who have been diagnosed as severely mentally ill. The
intensive mental health unit at Marion is the only such residential unit
operated by ODYS and is intended to serve all boys, regardless of actual
security classification, in need of this level of mental health care. ODYS
operates three “Non-intensive” Mental Health Units at other facilities for
boys who have “a moderately severe diagnosis and whose adjustment in
the general population would be compromised.” (Mental Health
Classification Standard Operating Procedure)
In addition to general housing units and the intensive mental health
unit, Marion also contains “Critical Program Unit” housing which is
analogous to an adult institution maximum security segregation unit.
Mental Health Staffing
At the time of the August site visit, mental health staffing consisted
of one full-time psychology supervisor, one full-time psychologist, one
full-time psychology assistant, one full-time clerical support person and 20


hours per week of an adult psychiatrist contractor. Notably, there were no
psychiatric nursing staff, no independently licensed mental health social
workers and no access to a child and adolescent psychiatrist (CAP). In
addition, I was informed that the psychology supervisor had submitted her
resignation and would be leaving in mid-September. ODYS Central
Office staff were unable to articulate an emergency/temporary coverage
plan for the psychology supervisor vacancy. We have since learned that a
contract has been entered into and that position has been filled.
Mental health staff assignments were aligned as follows:
psychology supervisor position to provide administrative function, clinical
supervision, crisis intervention and coverage for other psychology staff;
psychologist assigned to cover the Critical Program Unit and all other
outpatient care; psychology assistant recently reassigned to Intensive
Mental Health Unit full time (previously 50% outpatient and 50% mental
health unit) although he hadn’t yet started assignment full time on the unit
because of the need to terminate/transfer previous outpatients; 20 hours
per week psychiatric time to cover general outpatient, Critical Program
Unit boys on psychotropic medications and Intensive Mental Health Unit.
In addition to the mental health staff, one institutional social worker was
recently reassigned to the Intensive Mental Health Unit full time. (She
had previously provided part-time coverage there.) Notably, this social
worker is not Master’s prepared, independently licensed or a mental health
social worker per se. She also had not yet been on the unit full time at the
time of the site visit due to personal illness and participation in
departmental/institutional in-service training requirements (unrelated to
mental health training.)
Marion’s psychology supervisor was not aware of any plans to
increase mental health staffing nor was she consulted with respect to
staffing needs. Dr. Scott-Johnson from Central Office reported that an
additional 2.5 psychology positions, one psychiatric nurse position and 0.5
FTE occupational therapist had been approved and another social worker


position had been requested for Marion. She was not able to project when
the approved positions would be posted or ultimately filled.
Intensive Mental Health Unit (IMHU)
As previously noted, the Intensive Mental Health Unit is a 12-bed
mental health residential treatment unit designed to house youth diagnosed
as severely mentally ill according to ODYS policy and operating
procedures. Existing policy and procedures are not clear with respect to
admission criteria, continued stay criteria, discharge criteria,
programming/treatment expectations on the unit and they do not provide a
clear distinction between the Intensive and so-called “Non-intensive”
Mental Health Units. Dr. Scott-Johnson explained that referral into either
the Intensive or Non-intensive mental health units is made via discussion
between sending and receiving institutional psychology staff with ultimate
approval authority for transfer into or discharge from the units being a
function of Central Office. Notably, the psychiatrist is not involved in
admission or discharge decision-making process. Similarly, neither the
psychology supervisor nor the psychology assistant on site at Marion felt
empowered to make admission or discharge recommendations: they had
attempted discharge recommendations in the past without success and so
were resigned to working with whoever was sent to them for however long
they were there. The Marion mental health staff believed that at least half
of the boys residing on the Intensive Mental Health Unit were not
seriously mentally ill but rather displayed highly problematic behaviors as
a result of Conduct Disorder and/or antisocial tendencies.
At the present time, there are no mental health programming or
mental health related group activities on the Intensive Mental Health Unit.
The sole treatment modalities are monthly psychiatric follow-up for
psychotropic medication checks and infrequent individual sessions with
the psychology assistant. These are the same interventions and
frequencies of interventions as received by boys on the mental health
caseload residing in general population and receiving so-called outpatient


treatment. Approximately half of the boys on the Intensive Mental Health
Unit attend classes at the high school on site for six hours daily which
begs the question of why they wouldn’t be more appropriately housed on
either a Non-intensive Mental Health Unit or simply in general population
since they aren’t receiving anything resembling “intensive” mental health
treatment and are clearly functioning fairly well. I observed the boys who
could not attend regular school and so were attending a shortened school
day in a classroom on the housing unit. They displayed clear signs of
highly impulsive behaviors, hyperactivity and impaired attention span
suggesting un-treated, under-treated or treatment-resistant Attention
Deficit Hyperactivity Disorder (ADHD.)
Mental Health Treatment
At the time of the site visit, 51 boys were prescribed psychotropic
medications which represents approximately 18% of the population at
Marion. The complete mental health caseload consists of these 51 boys
and an additional 11 boys being seen regularly by psychology staff
(totaling 22.5% of the population.) By all existing prevalence studies in
juvenile correctional populations, this is a remarkably low prevalence and
indicates deficient screening, assessment and referral procedures and
practices – both during the reception process (addressed in the Scioto
section of this report) and subsequently.
Mental health treatment plans, if present, are developed
unilaterally by psychology staff without ever actually having treatment
team meetings. (There are other types of meetings at which individual
boys mental health needs and conditions are discussed but these do not
include all disciplines or the youth, and are not always documented in any
fashion.) Subsequently, it is not a surprise that mental health interventions
are parallel rather than integrated and this is reflected in the
documentation: psychiatric assessments, follow-up notes and medication
information are contained in the youth’s medical file while psychology
notes are contained in the “Psychological File.” The psychological files I


reviewed contained copies of some psychiatric notes, but no record of
psychotropic medications. Psychological files are maintained in the
psychology staff offices and are provided to the psychiatrist on request
when she is seeing cases. Each youth also has a social services file that
could contain additional mental health information. Additionally,
psychology notes and social service notes are in the process of being
entered into Microsoft Access Databases. At the present time therefore,
there are three paper files and two electronic files containing mental health
information for each youth. Due to the ODYS interpretation of
confidentiality rules and protected health information, not all disciplines
have access to all of these multiple files even though all may be providing
treatment to the youth.
Psychological interventions are frequently limited to crisis
interventions due to the paucity of staff available to provide any on-going
type of treatment. There is no departmental expectation regarding the
format for documentation of mental health sessions. (The psychiatrist
uses a Subjective, Objective, Assessment, Plan or SOAP format routinely
as her own personal preference.) Similarly, there is no department-wide
direction or prescription for type of psychological therapeutic
interventions provided although Central Office has recently initiated some
preliminary training and steps to adopt a model for providing traumainformed care throughout the department. Presently, essentially all mental
health treatment provided is via individual sessions with the psychiatrist or
a psychologist; there is no group treatment. No psychological testing for
diagnostic clarification, assessment or any other use of standardized,
objective instruments to monitor response to treatment are conducted at
Marion. The rationale for this omission in a system in which psychology
staff are the very backbone of the mental health system was inexplicable
by any of the on-site psychological staff. They said they had repeatedly
requested psychometric tools and that their requests were repeatedly
denied because of the expense involved. Central office staff


acknowledged that they had not been involved in securing these types of
materials for the institutions, but were “getting ready to see what everyone
needed.” The Deputy Superintendent of Programs said she was not aware
that psychological staff needed psychological testing materials but that if
they put together a list of what they needed, she would purchase the
On a brighter note, the psychotropic medication formulary is
unrestricted and all classes of medications are available. The frequency of
psychiatric follow-up is approximately monthly. The psychiatrist does her
own follow-up scheduling so is able to see youth more frequently as she
believes necessary. Laboratory studies and monitoring for potential
physical health complications from the use of psychotropic medications
are appropriate and timely. The psychiatrist herself generally obtains
verbal informed consent from a parent or guardian when a child is under
age 18. This is documented in the medical paper file. Informed consent
documents are also mailed to parents for signature and return.
Surprisingly, only 2 of the 51 boys receiving psychotropic
medications were prescribed stimulants in spite of the high prevalence of
ADHD in this population and stimulants being treatment of choice for the
condition. When queried, the psychiatrist explained that some boys had
previously failed trials of treatment with stimulants; and some parents
refused to consent to stimulants. Subsequently, she prescribed Clonidine
and/or atypical antipsychotic medications and/or mood stabilizing
medication for diagnoses of ADHD and affective disorders. (I suspect the
exceptionally low use of stimulants is also due in part to the fairly
conservative prescribing practice of the adult psychiatrist herself since
treatment failures on previous trials was certainly not documented
anywhere. Other contract psychiatrists use stimulants more frequently.)
[On further reflection, the author of this Report wishes to make it
clear that there is room for legitimate disagreement here as to the
prevalence and use of medication for the ADHD population.]


Youth in the custody of ODYS have no access to inpatient
psychiatric care until they are 18 years old and can be hospitalized in a
state psychiatric hospital. Dr. Scott-Johnson and Dr. Marrow both said
that they have tried to secure a contract with an inpatient psychiatric care
provider to no avail because all providers that have been approached have
refused to serve this population.
The very basics of fundamental mental health care are seriously
lacking at both Marion and Scioto Juvenile Correctional Facilities.
Existing policies and procedures lack sufficient detail and clarity. Mental
health treatment is essentially limited to either crisis intervention and/or
psychotropic medication. This is partly based upon inadequate staffing
levels but also based upon a culture that appears not to recognize that they
are missing substantial numbers of youth who need treatment. Caseload
prevalence data alone is indicative of deficient screening, assessment and
referral procedures both at the time of reception and subsequently.
Additional clinicians, including independently licensed, master’s prepared
social workers, psychiatric nurses and clerical staff are needed
Mental health treatment records are fragmented at best. There are
at least five files containing mental health information, three paper files
(medical, psychological and social services) and two electronic files
(psychological and social services). Although this is part of a transition to
an eventual fully electronic file, it is not acceptable at the moment because
not all parties providing mental health interventions are permitted access
to all parts of the information! The fragmented nature of the
documentation is a reflection of the fragmented care provided.
The psychotropic medication formulary is open and unrestricted.
However, there appears to be a profound underutilization of stimulant
medications for the treatment of ADHD, particularly among the males at
Marion who were observed to be exhibiting highly problematic symptoms


and behaviors of the disorder, but also among the girls. I believe this is
partly a cultural issue in which the use of stimulants was not supported by
the ODYS medical director in the past, as well as the fairly conservative
prescribing practices of the psychiatrist, Dr. Neidermeyer, [see author’s
comment at p. 60, supra] in addition to the issues she raised with respect
to lack of guardian consent in some instances. However, I also believe
that the lack of access to a Child and Adolescent trained psychiatrist,
either to provide services directly or to serve as a consultant, is a serious
problem for ODYS and impacts upon the ability to secure guardian
consent as well as a myriad of other areas, not the least of which is
recognition of the profound psychological and emotional developmental
delays experienced by these youths.
The two residential mental health care units I visited were little
more than housing units. There was essentially no mental health program
above that available to any other youth in any other housing unit at either
facility: some social service groups (not considered mental health),
individual monthly psychiatric appointments, psychotropic medications
and occasionally, some individual psychological intervention (mainly
crisis intervention.) I will not dwell on the Scioto use of “restraints upon
request” again except to reiterate that this practice falls well outside the
accepted standard of care. Lastly, the inability to access an inpatient level
of psychiatric care is a grave and clinically dangerous situation that should
be addressed immediately.
[End Burns Report]

What has been said of Scioto and Marion can be said of the other DYS facilities
with variations based on size and mission. Dr. Leta Smith visited and reported on all six
facilities visited by the “core team” and prepared a comprehensive summary of those


As with Dr. Burns’ Report, Dr Smith’s excellent “Summary” should be allowed
essentially to speak for itself. It is presented in an edited version and represents this
writer’s individual findings as well. There is some overlap with areas previously covered,
but in my view the overlap tends to strengthen the points and does not appear to be

Summary Report Of Initial Site Visits: Leta D. Smith, Ph.D., 10/7/
Overall, the provision of mental health care and treatment
throughout ODYS is fundamentally deficient and structurally inadequate
in design and function. Although reported percentages vary from facility
to facility, the identified mental health caseload of roughly 25-35% is
notably low (e.g., Marion 23%; ORV ~1/3) compared with other states
and as cited in the prevalence literature, suggestive of inadequate mental
health screening, assessment, and referral processes. This is a serious
deficiency as it leaves unidentified youth potentially at risk of unmet and
untreated mental health needs, symptoms which may deteriorate or
exacerbate, and the behavioral manifestations of their illnesses to
potentially jeopardize their own safety and that of other youth and/or staff.
Given the extremely limited clinical staffing throughout the system of
mental health care, a youth who may be quietly suffering could easily be
overlooked and needed mental health services neglected. According to
psychiatry at Indian River Juvenile Correctional Facility (JCF), depression
and anxiety disorders are under-diagnosed because youth do report their
symptoms for fear of looking weak. Meeting with non-mental health
caseload youth can contribute to early detection and possibly prevention of
mental/ emotional disturbance, crises situations, and deterioration to more
serious conditions.


The vast majority of youth on the mental health caseload statewide
were identified at Scioto Reception (see Intake below) and/or receiving
psychiatric medication, with the remainder referred by social work or
other staff generally for acting out or ‘weird’ behavior [Ohio River Valley
JCF (ORV)]. For example, at Scioto, because of staffing constraints and
other impediments to adequate treatment (discussed below), Psychology
infrequently meets with girls on the mental health caseload for
individualized non-crisis oriented treatment, and rarely meets with the
non-mental health caseload youth. Depression is one of the most frequent
diagnoses, especially for mentally health caseload females in the juvenile
justice population, with psychotherapy as the treatment of choice,
according to the American Academy of Child and Adolescent Psychiatry,
along with careful administration and monitoring of SSRI medications if
The result of a lack of appropriate recognition and response to
serious mental health disabilities can result in self-harm, harm to others,
and/or inappropriate punishment for acting out behaviors.
In a most major areas of mental health governance and service
delivery ODYS lacks adequate policies and protocols. These policies and
procedures must clearly articulate expectations and consequences for noncompliance.
Aside from the inadequacies in content, there does not seem to be
the requisite clarity and working knowledge of existing policies and
procedures by clinical administration or staff. There seems to be confusion
over what are existing, newly adopted, and/ or unofficial draft policies and
procedures. This may, in part, be the result of recent changes, some of
which were driven by our team’s findings, in administration, staff, and
policies, procedure and practice. Written policies and procedures need to
meet good practice standards, but more importantly must be explicitly


articulated, internally consistent, and communicated/disseminated so that
administration and staff are clear about expectations.
Policies and procedures are the minimal guidelines for service
delivery and help to define what services should be provided to which
youth. To illustrate this point, per SOP 403.30.02 Psychology Services,
youth on the mental health caseload who are identified as appropriate may
be (emphasis added) provided with individual treatment sessions.
Another blatant example is the lack of clarity as to mission and
official policies/protocols concerns definitions and operations of the
Special Needs as well as Intensive and Non-intensive Mental Health
Units. This has resulted in grossly inadequate mental health services for
those youth with the most serious levels of mental health need. There
continues to be an absence of mental health programming or groups;
inadequate staffing, training, etc. The needs of youth with serious mental
health disabilities are neither understood nor adequately addressed, despite
almost 10 years of recommendations to correct these gross inadequacies.
This situation continues to pose serious risks, and is a serious waste of the
appropriated limited clinical resources.
Decisions to develop or define facility mental health programs
(policies, procedures, protocols, staffing, space, etc.) must include review
and signoff by the clinical mental health hierarchy through Central Office
in order to promote informed decision-making and present consistent staff
expectations and accountability. A unit’s clinical supervisor and/or
clinician should be an integral stakeholder in this endeavor.
Other Procedure:
Consequence Log - Of serious concern is the use of a Consequence Log at
Indian River’s NIMHU which JCOs can use to cite certain behaviors
without review of the UBIR process; however, this counts against the
youth. This is a “slippery slope” and needs close attention.


Quality assurance and peer review procedures are grossly
insufficient. Although there are some worthy data collection efforts (e.g.,
Performance-based Standards Project; Circleville recidivism data), as the
mental health program and staff expectations are clarified, quality
assurance and peer review procedures must be developed.
Staffing competencies, performance indicators/outcome measures
and formal systems of care coordination (integrated treatment plans and
meetings, records, logs, communications) are largely undeveloped aspects
of a quality service system. Monitoring of staff performance is needed,
based on clearly specified staff expectations.
The Mental Health Administration has been working to establish a
mental health database, which they feel will provide some means of
monitoring clinical performance (e.g., individual contacts, family contact,
etc.). Although the new database offers some information concerning the
nature and amount of staff contact with youth, it does not rectify the
problems with ODYS individual treatment planning and perpetuates the
lack of integration between the disciplines (see Adequacy of Mental
Health Records below). Without necessary quality improvement systems,
there is no adequate clarity of clinical vision or purpose, ability to monitor
performance, nor necessary systematic capacity to identify and improve
In the context of a comprehensive mental health system, it is
essential that ODYS develop competencies in specifying and assessing
individual improvement toward mental health goals, along with clinical
performance, in order to move toward individual youth and staff progress
and positive outcomes.

Mental health staffing does not yet support or promote adequate

treatment in accordance with good practice standards of care for juvenile
justice mental health. The lack of mental health staffing significantly


compromises the safety and well being of youth by failing to support
opportunities for adequate assessment, treatment or follow-up mental
health services, especially given the large proportion of youth with
extensive mental health needs.
Clinical staffing must be increased, preferably as part of a
coordinated plan to reduce the facility census.
The absence of effective mental health leadership continues to be
of great concern. We find a failure to adequately recognize and respond to
the serious and complex needs of the mentally ill youth in the ODYS
system; a demonstrated lack of knowledge of pertinent issues; and little
evidence of leadership and commitment to advocate for critical mental
health system needs and required change.
Facility Clinical Leadership Positions:
Facility clinical leadership positions cannot continue to remain
unfilled. Vacancies in some facilities in the positions of Program Deputy,
Psychology Supervisor, and/or Social Work Supervisor create a void in
clinical leadership, supervision, advocacy and support for the mental
health program (see below).
Psychiatric services are extremely limited and for the most part, do
not include much more than brief medication monitoring every 30 days.
At ORV for example, one psychiatrist provides 2-3 hours of services per
week with 121 youth on psychiatric medications. With so few hours the
psychiatrist cannot participate in team meetings including the clinical
team, nor meet with psychology. Extended periods of time between
medication reviews, along with limited opportunity for monitoring and
follow-up at each visit, increases the risk of untoward medical, emotional,
and behavioral outcomes.


Social Work:
Social workers are largely case managers who provide behavioral
groups. In order to begin to establish mental health staffing ratios, ODYS
must clarify whether Social Workers as presently trained and credentialed
should be included as clinical staff. If social workers are to continue in
their stated role as clinicians, then their credentials and job expectations
must be commensurate with professional standards. Under present
circumstances, there is a major problem including social workers who are
not appropriately trained and credentialed as clinical staff.
Most of the social workers encountered at the various facility site
visits hold bachelor’s level degrees if they have a license. It is important
that any additional mental health unit social work staff are master’s level
licensed social workers (MSW, LICSW, etc.) Given the Union constraints,
and that ODYS social workers almost exclusively do case management
and behavioral groups, ODYS might consider clinical titles other than
social worker (e.g., psychologist, mental health nurse), when enhancing
current levels of clinical staffing, until and unless master’s level social
workers become the standard. Perhaps the current social work title would
more appropriately serve as the ‘therapeutic’ Unit Manager to support
system needs.
Psychology is greatly understaffed, resulting in a crisis- oriented
approach, and largely precluding the ability to provide needed individual
preventive, on-going, and follow-up treatment. Since psychiatric hours are
few, and many social work staff have questionable clinical credentials, this
leaves Psychology with the responsibility for treatment, provision of
clinical groups, as well as providing assessments, clinical input for unit
staff, contact with families, etc. As a result, mental health needs largely go
untreated and related risks increase due to the understaffing.


Psychiatric Nurse:
Aside from Scioto, I am not aware of other mental health nurses in
the system. A Psychiatric nurse is an important interface in conveying
clinical information to and from the psychiatrist, monitoring side effects,
and behavioral and emotional adjustment, and providing individual and
group medication education.
As proposed at Marion, for example, a minimum of 0.5 FTE
Psychiatric Nurse could provide support for the Intensive Mental Health
Unit and also serve an additional .25 for the general population and .25 for
the CPI/ disciplinary unit.
Occupational Therapist (OT) and Recreational Therapist (RT) Services:
OT and RT provide valuable support for mental health populations,
especially those on units with more intensive mental health needs because
they can provide fine and gross motor activities as well as tasks which
focus attention and have a high probability of success for individuals
suffering from serious mental illness. These activities promote self-esteem
and self-confidence for mentally ill youth who are frequently unable to
participate in the more challenging schedule of general population. As part
of an individual treatment plan, these activities also help youth divert
excess physical energies into positive/ constructive activities, rather than
negative emotional disturbance and/or behavioral acting out.
Clerical support:
Most facilities do not have clerical support that is essential to
timely clinical communication, documentation, record-keeping, and
monitoring. Without clerical support, clinical information frequently
cannot be processed and shared with Team members as needed to provide
appropriate program placement decisions and treatment response.
Moreover, valuable clinical time necessary for provision of assessment
and other mental health services for youth is otherwise ‘wasted’ on
clerical tasks, unnecessarily increasing the risk of harm due to unmet
clinical concerns. (This is not unlike the dentist situation where dentists


do “prep” and other work typically done by unavailable dental
As previously stated, in order to begin to determine clinical staffto-youth ratios, the qualifications of social worker must first be clarified.
Facility size, physical plant, and level of care as part of a defined
continuum of mental health services are all relevant to these decisions.
Adequate case finding is necessary to determine the extent of mental
health need throughout ODYS in order to plan for and define a system of
care. Notwithstanding these issues, it is clear that clinical staffing is
Once the extent of mental health need is assessed, it is likely that
ODYS will find that most youth have mental health needs that can be
served in the general population given adequate resources and program
support for the provision of clinic services. Adequate mental health
clinical staffing is necessary in general facility populations where the
majority of the youth with mental health needs reside. They require:
ongoing monitoring, brief intervention, and/or continuing mental health
services. This model also contributes to prevention by early identification
and intervention before mental health deterioration and decompensation.
For the purpose of this draft, clinicians are defined as
psychologists, licensed master’s level social workers, and psychiatric
Although there are no formally accepted national standards for
clinical staffing ratios for the juvenile justice setting of which we are
aware, staffing ratios will be offered here as general guidelines and a basis
for settlement talks based on the professional experience and expertise of
the team. Generally accepted clinical staffing for children and youth is

The staffing ratios provided in this and the following sections are offered in the context of litigation
leading, hopefully, to a settlement. They should be viewed as springboards to discussion and not fixed
ratios to be “defended” by the Team.


double that of adults. Given the particularly serious, complex, and deeprooted mental health issues evidenced in the female juvenile justice
population, even richer ratios are justified. The literature demonstrates that
the mental health needs for females are far more complex and extensive
than their male counterparts, whose needs are also significant.
Staffing ratios should meet the need to provide an individualized
treatment plan and needs for each youth, with prescribed interventions
toward specified goals and youth outcomes and group sessions to address
pervasive youth clinical needs (e.g., co-occurring substance abuse and
mental health diagnoses). Overall facility population clinical caseloads are
proposed at a ratio of 1 clinician to approximately 15 identified mentally
ill girls (i.e., 1:15). This level of staffing would allow youth individual
therapy up to twice a week, and still provide the opportunity to attend to
the other clinical functions (e.g., suicide watch, discharge planning, etc),
as well as time consuming ancillary functions. Clinical staffing levels for
males in general population might be considered at 1 clinician to 20 (i.e.,
Adequate psychiatric resources are also necessary to provide
medication monitoring and adjustment as dictated by ODYS policy and
good practice, along with other traditional psychiatric services.
Recognizing that Child and Adolescent psychiatrists are a scarce national
resource and traditionally few and far between in juvenile justice settings,
every effort should be made to attract and cultivate partnerships (e.g.,
through Child Psychiatry and Forensic fellowship programs) with
individuals who have training and expertise in child and adolescent
psychiatry. Dr. Burns, of course, echoes this call.
Psychiatric support is proposed at 1:60-80.
The Mental Health Units must provide a level of staffing to ensure
a safe and therapeutic environment. Clinical staffing patterns for each
IMHU include a minimum of two (2) and preferably three (3) full time


equivalent (FTE) mental health clinicians and a Treatment Team Leader.
The goal is to establish a multi-disciplinary treatment team, with a
Treatment Team Leader and the remaining FTE’s selected from the titles
of Psychologist, Licensed Master’s level Social Worker and Psychiatric
Nurse. A minimum of 0.2 FTE (preferably 0.5 FTE) Psychiatrist is
necessary for the IMHU (plus an additional minimum of 0.3 FTE,
preferably 0.5 FTE Psychiatrist for identified mentally ill youth in the
facility general population.
In order to determine appropriate levels of staffing and number of
non-intensive mental health units needed, programs must be defined as
components of a continuum of mental health care. 20 Other relevant factors
are discussed at the beginning of this section. If ODYS determines that a
number of NIMHUs are necessary then perhaps additional classification
considerations (e.g. age) could be added. Depending on program
definition (see Section K), the population for a step-down or intermediate
care program should not exceed 20 and should be staffed similarly to the
IMHU given that the number of beds would be nearly double. If located
proximate to the NIMHU, the Treatment Team Leader as well as the
specialized support staff (e.g., OT, RT) could be shared. Additional
psychiatric services (~ 0.2 FTE) would be necessary.

Without a safe environment, effective treatment, programming,

and/or learning cannot take place. Treatment and security go hand in hand,
each required for the effectiveness of the other. All personnel must operate
with the expectation and understanding that they are, in effect, part of a
Treatment Team, in which they function to support the treatment/
rehabilitative goals.


The term “Intermediate Care Units” as preferable to Non-Intensive Mental Health Units. Non-Intensive
is inaccurate since seriously ill youth could be on this unit, requiring more enhanced care than available in
the general population.


Currently JCOs function almost exclusively as custodial staff. The
addition of mid-level managers (i.e., Unit Managers) has provided some
ameliorating this security predilection; however, administration must
support the UM’s important functions by minimizing their needs to be
pulled from their units for a variety of purposes.
Juvenile Correctional Officers (JCOs) ultimately should be
integrated into the treatment team. Behavioral issues should be addressed
by JCOs within the structure of an effective behavioral management
system, with an individual plan as indicated. The Ohio JCO job
description, now ignored, specifically includes implementing treatment
services for mental health, sex offender, and chemical dependency
Filling all Program Deputy and Psychology positions is essential in
order for there to be appropriate facility clinical leadership presence,
clinical support and supervision. A number of these positions have been
vacant which drains scarce clinical resources to cover supervisory
functions and more importantly further dis-empowers the clinical
program, particularly when combined with an absence of mental health
leadership and supervision in Central Office (e.g., Circleville CJF)
Mental health in-service for clinicians as well as for all levels of
staff is inadequate, thereby compromising their ability to respond as
effectively to the serious mental health needs that the ODYS population
In-service opportunities must provide consistent messages, tied to
clear expectations, including but not limited to newly articulated policies
and protocols. For training to be effective, credible, and productive, it
must be clearly coordinated, planned, and delivered.


Clinical staff need system-wide consistent clinical enhancement
training (e.g., DBT, treatment planning, etc.). Currently clinical staff are
able to pursue additional clinical training of their own initiative and
choosing, and to then be reimbursed by ODYS. While this opportunity can
provide a positive supplement, the mental health administration must
develop its own core clinical curriculum in order for all clinical staff to
have requisite training and skills that are expected and supported by the

Staff need to develop specific individual treatment plans and goals,

and assess progress toward these goals. Plans need to include interventions
that are strength-based, work toward specific individualized goals, and
include families whenever possible in treatment planning and delivery.
Current ODYS treatment planning is generally inadequate. Progress notes
are not in standardized (SOAP) format. Without an integrated treatment
plan, a coordinated and purposeful treatment response does not exist. The
separate systems of clinical record-keeping are an obstacle to integrated
and effective planning and treatment. In general administration and staff
do not seem to be clear on what a treatment plan is and particularly a
coordinated treatment plan.
There is no single unified mental health clinical treatment plan
where the youth participates in setting goals with steps to get there, and
where progress is measured and documented. There needs to be one team
that sets a normative culture and speaks a common language that
addresses the treatment of all aspects of the youth’s behavioral and
emotional health and well-being. There needs to be a ‘holistic’ approach,
so that there are consistent goals for the individual youth and so that staff
of the various disciplines function as a team and provide informed and
consistent direction and support for successful youth treatment outcomes.
Treatment and security are being compromised by the current


Also noted consistently in all reports since 2004, ODYS has not
established an integrated clinical hierarchy, treatment plan, or
documentation system. Psychology is not a component of a
multidisciplinary treatment team in the commonly accepted sense. The
record keeping is a nightmare, even with the new database. It is not in a
standard medical record format. There are at least four separate records
[i.e., psychology, social work (Unified Case Record/general file), school,
and medical record]. There is no single mental health clinical treatment
plan. There is a psychological file and a psychology database, not a mental
health file. The Special Management Plan is not part of the database. The
Clinical Team Meeting notes are not kept in the file. It is extremely
difficult to find necessary clinical information with the beginning of a
database and paper files in multiple locations. The paper files are not
ordered consistently, and the records could benefit from tabs. The
Circleville clinical program is further limited by the absence of a
centralized file system, and psychology’s inability to access each other’s
files without a cumbersome time-consuming process. This fragmented
means of documentation and communication impedes integrated treatment
planning and necessary sharing of information for continuity of care.
There are a number of meetings where youth on the mental health
caseload are discussed, but they are neither consistently held nor
documented throughout the facilities. Psychiatry Team Meetings are
intended to include psychiatry and psychology; Clinical Team Meetings to
include psychology, social work and unit manager; and Interdisciplinary
Team (IDT) meeting which is scheduled once per week and includes
social work, psychology, UM, JCO, with until recently, the occasionally
participating education, recreation, and/or health personnel. The IDT
seems to be the best documented meeting; however, suffers from lack of
psychiatric participation, limited opportunity/ time to discuss each youth,
what staff expressed as a major focus on behavioral/ custodial concerns,
and limited capacity for psychology’s direct participation given multiple


simultaneous meetings and one/few psychology staff. This limits
integrated treatment planning with the risks and liabilities of failing to
communicate and address treatment needs.
Effective treatment of youth does not and cannot occur until there
is integrated treatment planning, communication and documentation.
As discussed in the 2004 report regarding Scioto, youth were using
the threat of suicide as a means of gaining attention or the opportunity to
speak with psychologists. The relatively few psychologists spent most of
their time responding to crises. Obviously suicide threats and the need to
perform risk assessments further limits psychology time and ability to
provide other treatment aside from crisis intervention, and reinforces such
attention-seeking behavior.
While it can be difficult in many cases immediately to distinguish
definitively between a suicide gesture and attempt, youth remain on
suicide watch for questionably long periods of time, at Scioto, up to 30
days or more. Extended suicide watch beyond several days is rarely, if
ever, clinically warranted. Extended use of watch is generally indicative
of the need for youth to be receiving 1) more adequate assessment, 2)
therapy and/or 3) hospital level care.
There are youth who seek suicide status as a means of gaining
safety from perceived or actual threats in population. Clinicians at ORV
(Psychologists and Social Workers) note the increase in manipulated use
of suicide watch to escape potentially threatening situations during the
past seven to eight months. The number of suicide watch and behavior
status also hit an all time high over the first seven months of 2007
increasing from 11 to 29 on suicide watch, 4 to 6 on observations, and 11
to 27 on behavior status.
Psychology indicates that they have seen a dramatic increase in
youth who report being scared of peer violence, who are not on the mental


health caseload, but who are manipulating suicide watch, once again, in
pursuit of a safe haven. Now precautionary status is not just for the
psychiatrically vulnerable but is a result of a highly stressful environment
for youth, and certainly for staff as well.
Safety Plan – According to the revised 2006 SOP concerning
Youth Disciplinary Procedures, a Safety Plan is a special management
plan written to specifically manage assaultive and/ or threatening
Special Management Plan (SMP) is a procedure designed to
decrease severe and/or chronic problem youth behavior(s).
The 2002 Special Management Plans Standard Operating
Procedures (SOP) 305.01.01 requires that SMPs are to be signed ‘by the
Psychology Supervisor (at institutions where there is one), Deputy
Superintendent of Programs and Superintendent or designee.’ If an SMP is
developed for a youth on the mental health caseload or being followed by
psychology, the plan must be signed by a psychologist. SMPs requiring
the use of seclusion…will be reviewed on at least a weekly basis. As the
Psychology Supervisor position was vacant at Scioto, for example, nonclinical staff provided signoff.
Mohican and Indian River JCF were more effective in having
psychology sign-off on an SMP for a youth on the mental health caseload
or followed by Psychology. Both the Psychologist and the facility
Program Deputy Mohican agreed that the Psychologist can refuse to sign a
youth’s SMP and this will be supported by the Program Deputy. In
discussions with these staff, they recalled specific cases.
The Psychologist notes that the goal is to keep youth out of
seclusion and the SMPs are intended to help youth learn how to do so. The
Psychologist and Social Work Supervisor are first to review the plans at
Indian River and this way can reject them if they are clinically unsound.


However, even with their good intentions, with all the youth on their
caseloads, and so many SMPs, some plans may ‘fall between the cracks.”
As discussed further below in Section M., these plans for the most
part are not individualized, strength-based, tied to treatment goals, nor
providing adequate incentives. Plans routinely include what we believe is
constitutionally excessive use of seclusion and frequently do not involve
clinical signoff in non-mental health units.
The Standard Operating Procedure (SOP) for Mechanical
Restraints 301.05.02 requires that ‘Mental Health staff shall conduct an
initial assessment of the youth upon notification of mental health or
psychiatric concerns or when youth are restrained beyond 4 hours. JCOs
must report any health or mental health concerns immediately to nursing
staff and/or mental health staff and the Unit Administrator/Operations
In the event that restraints may be necessary to prevent self-injury,
a more restrictive separate SOP 301.05.04, Mechanical Restraints Used for
Psychiatric Purposes applies. Both of SOPs are relatively new and issued
in 2006. The SOP for psychiatric purposes to prevent self-harm requires
that mechanical restraints ‘shall only be applied with the approval of the
Superintendent and institutional Psychologist, Psychiatrist or Physician.’
The use of mechanical restraints for these purposes is fairly well defined
to include procedural requirements for a suicide risk assessment, less
restrictive interventions (but other forms of restraint nonetheless), along
with a plan which limits their use to an hour, with constant visual
monitoring including interaction, etc. JCOs who monitor the youth are
required to report any health or mental health concerns immediately to
nursing, and/or mental health staff and the Unit Administrator/ Operations


The Circleville NIMHU is the only ODYS mental health unit with
two tiers, having 12 rooms upstairs, and 12 down. The tiers are open, and
also have vertical rail bars. Youth who are doing best have beds upstairs.
This physical plant design poses an unacceptably high suicide risk,
especially for youth with more serious mental health disabilities who are
already at higher risk of self harm and suicide as evidenced by their
placement and retention on the NIMHU. The physical plant is ripe for
diving into the floor below, surely resulting in serious injury and/or death,
and/or hanging from the rungs on the rails, which provide no meaningful
protection from jumping, diving, or hanging. There are relatively easy
physical changes that should be made as suicide prevention measures. 21
The condition of the two rubber rooms at Indian River is
disgraceful, and again seriously limits the ability to provide necessary
protection for youth who require this room to prevent self-harm as a result
of their mental illness. The rubber rooms actually are not seclusion rooms
but safety rooms.
Other youth outside the NIMHU are brought onto the NIMHU,
mostly at night, when they cannot be managed elsewhere in the facility for
their behaviors. For these facility youth, Psychology does not decide on
entry and release from these rubber rooms. According to staff and youth
reports, these youth disrupt the Unit with their loud noise, preventing them
from sleeping, and intensifying their emotional distress.
Non-NIMHU youth have trashed the rubber rooms. There is
graffiti carved into the walls, floors, and ceiling, including with pen. One
rubber room has at least a 10-inch circle where the rubber is ripped out of

For example, encase the railings so there are no spaces and no ability to leap over the second floor railing
and remove/repair loose and broken floor tiles, which can pose a potential risk for being used for cutting
self or used as a weapon.


the door, exposing wood and leaving the loose door rubber exposed,
posing hazards for health and safety by ingestion and head banging. The
second Indian River rubber room is also covered in graffiti and ripped up
by youth in cuffs severely misbehaving from the E Unit. The damage to
the door of the second rubber room is even greater than the first. Neither
of these rooms may now be used for mental health purposes as intended.
One youth on the NIMHU caseload routinely bangs his head on the wall,
but the rubber rooms cannot be used to protect him.
No youth from outside the NIMHU should be brought onto the
Unit. While there is a need for certainly of protective, simple room
housing there must be a more appropriate place designed to house victimprone and victims of violence.
The rubber room at Marion Intensive Mental Health Unit also
continues to be unavailable because a youth bit a hole in the wall. That
room is unavailable for use by the youth who have ‘intensive’ mental
health needs and are at the highest risk of harming themselves or others.
The very term “rubber room,” with its disgraceful, mental hospital
implications, and then the room itself and questionable usage calls for an
urgent change in policy and procedure for youth who require brief periods
of time in a safe place to sleep.
At ORV (McGuffey), what distinguishes Suicide Watch rooms
from other unit cells is that there are no shelves and that they have two as
opposed to one window for observation. The metal beds provide
unacceptably high risk factors for suicide and/ or harm to self or others.
Although Intake is not in a mental health unit, youth at intake are
among those at highest risk of suicide. The wet room at Indian River’s
Intake Unit is also used for suicide watch. Everything is in view except the
shower, which has handicap bars and can be observed only through a
small window slot in the outer hallway. This is a high risk area. [Another


major risk in using this room for suicide watch is the metal bed with legs,
which should be replaced with a safety bed.]
The impact of the systemic lack of dedicated physical space for
clinical services is most blatantly exemplified at Indian River. In order to
provide necessary access to Psychiatric treatment, Psychiatry needs a
dedicated clinically appropriate space to meet with youth on their
caseload. The time psychiatrists and social workers spend looking for a
clinically appropriate space, locating and transporting youth, and finding
ancillary clinical information obviously diminishes the limited psychiatric
time available for providing necessary and timely treatment and
monitoring of youth.
Mental health care, at all facilities, requires a dedicated clinically
appropriate space, assigned JCO transport of youth to and from their
appointments, and necessary integration (including space proximate to
clinical staff) between the disciplines for sharing of critical clinical
information. All of these improvements would enhance fiscal efficiency
and professional time needed for provision of treatment.
There are five of double bunk beds on the NIMHU at ORV.
Although they are kept vacant, bunk beds provide an opportunity for youth
to dive into the floor from the top bunk. The upper bed, even if
unoccupied provides an unacceptable suicide risk for this population. They
also provide the capacity for double-bunking which contributes to the
level of aggression where they exist. Clinical staff on the NIMHU noted
that some of the emotional and behavioral improvement of youth on their
unit can be attributed simply to the single bunking.
Safety furniture
Safety furniture is a commonly accepted standard for mental health
populations. Metal bunk beds are unacceptable on a mental health unit


(e.g., Circleville NIMHU) as they pose safety risks for their potential for
affixing a ligature and their sharp edges. Units should also have sand
chairs or some form of heavier chairs (such as Moduform) rather than the
standard lighter chairs (e.g., Circleville NIMHU) so they cannot be
NIMHU Ceiling Grate
The Circleville bathroom ceiling has open grates which can
provide unnecessary suicide risk as a ligature can be suspended or affixed
to the grates.
Door Stop, Door Handles, Sink Fixtures
Even the rather simply remedied physical plant recommendations
from the Team’s first site were not addressed at the update visit to the
Marion Intensive Mental Health Unit. The door stop behind the
conference room door was not removed as recommended, presenting a
continuing suicide risk for a population with intensive mental health
The other recommended repairs also remained unaddressed. This
includes the door handles and sinks that need to be replaced with more
suitable fixtures for this population. The door handles pose suicide risks
and do not meet the commonly accepted standard for this population. The
sink fixtures are easily disassembled and can be used as devices to cut self
or others. The IMHU has already experienced this problem a number of
times but rather than replace the sinks has continued to simply repair the
same sink fixtures.
[Information received after these issues were raised strongly
suggest that ODYS is being responsive to the physical plant problems
identified at Marion.]
Lack of Adequate Cameras
Throughout the system greater video camera coverage is needed.
Staff and youth claim peer and staff abuse in areas where there is
inadequate camera coverage (e.g., ORV sallyports). Indian River NIMHU


is developing a comfort room that is being planned near the end of a
lengthy hallway of cells. Cameras should be installed to enhance
necessary monitoring and to avoid the risks of self-harm and other
potential abuse in the use of this fairly isolated room. Additionally, there
needs to be a clearly articulated program with policies and procedures for
utilizing the comfort room.
A capacity for psychiatric inpatient hospitalization is a critical
component of a mental health continuum of care that currently is lacking
in ODYS. A mental health unit does not and cannot provide hospital level
care. It is totally unacceptable, legally and as a matter of policy, that there
is no identifiable means to access psychiatric inpatient care for youth
under age 18.
This section will more specifically discuss the lack of an ODYS
continuum of mental health care. Access to and the extent to which
program beds need to be developed has been discussed. The adequacy of
program beds is a moot point when the units have no clear purpose or
definition. There are no formal admission, retention and/or discharge
criteria or policies and procedures for these program components/ units.
The mental health programming on the mental health units is
largely indistinguishable from that on the other units. The unit staff have
little-to-no additional mental health training, and additional treatment
protocols have not been clearly defined. As has been noted, an integrated
treatment team needs to be developed, with the JCOs included as integral
members of the team in order to provide a coordinated and consistent
treatment response.
[End Smith Report]


Certainly, any reader who has come this far will conclude that there simply is no
mental health program worthy of the name now functioning within ODYS. There are
certainly a series of ad hoc arrangements for care; there certainly are some dedicated
providers of care who struggle daily to help, but minimal constitutional obligations are
not being met and, sadly, this was the theme of the November 2004 Report.
We constantly hear a series of “we can’t,” “we tried,” “we didn’t know,” and
“we’ll do better.” This reminds me of a term I heard used by Federal District Court
Judge Thelton Henderson in describing the dysfunctional California Department of
Corrections as staffed by persons with “trained incapacity.”
At this point, however, an absence of funds or the difficulty of recruitment may
serve as explanations but not as valid excuses for not having an acceptable mental health
The remainder of Dr. Smith’s full Report discusses continuum of care issues in
the form of units designed for intensive care and intermediate care and the need for
programs and services in the various restricted housing units. Those areas of discussion
and her concluding sections may be consulted but are not offered as findings by this
It is of the highest priority that ODYS cease and desist from the extended terms of
de facto punitive isolation practices while adopting measures to assure the safety of youth
and staff. This will require staff enrichment, design modifications, new policy &
procedures, and close oversight. Beyond this troublesome area, DYS officials should
avoid the ad hoc responses to mental health care crisis — crisis that emerged because
they were observed, not sudden events — and develop, staff, and implement an overall,
comprehensive plan for a continuum of care.


Section IV, Mental Health Care

Initiatives in place to address Treatment:
• Ohio has been selected as one of four states to participate in the MacArthur
Foundation Models for Change Mental Health / Juvenile Justice Action Network
Grant. This initiative focues on system reform in mental health and substance
abuse services for youth involved in the juvenile justice system, including DYS.
It will assist Ohio’s juvenile justice system in developing and implementing
improved policies and practices based on the best available research and
techniques for mental health and substance abuse services.
• Because of the amount of trauma that ODYS youth have experienced, ODYS is
working to equip staff with more effective ways of working with a highly
traumatized population. There is a Childhood Trauma Task group assembled to
develop staff training on the prevalence and impact of trauma and provide
strategies for assisting these youth to cope and point out how “traditional”
correctional practices have the potential to be re-traumatizing.

Training on Trauma Informed Care has begun and ODYS senior staff, psychology
staff, social work supervisors and mental health unit staff will be included in the
training as well as unit staff. As of December 2007, Dr. Marrow has trained well
over 100 staff assigned to mental health units using the 6-hour trauma informed
care curriculum.


Trauma related programming has begun for the female population utilizing
nationally recognized clinician Stephanie Covington’s work, with additional
programming being developed for the females and males to assist them in
managing their own trauma.


ODYS, in collaboration with the Ohio Department of Mental Health, is funding
the implementation of the curriculum Trauma Affect Regulation: Guide to
Education and Treatment (TARGET) through a contract with Advanced Trauma
Solutions. The curriculum was selected by the Trauma Steering Committee and is
a promising practice developed by nationally known expert, Dr. Julian Ford.
Intensive training for mental health units began in September 2007 and will
continue in January 2008.


Submitted by ODYS to Fred Cohen on December 21, 2007. Fred Cohen excised some of this submission
and slightly edited other parts.


• Capital funds in the amunt of $2.85 million were secured for the FY07-08 biennium with
the anticipation of building or restructuring the mental health units.

The programming, environment, and staffing are being modified on the male and female
mental health units. The new curriculum addresses the specific mental health needs of
the population by focusing on stabilization, emotion regulation and the development of
coping skills. This program integrates different phases with a richly staffed unit, sensory
programs and therapeutic atmosphere. The last phase will focus on preparing the youth
to return to a lower level of care or for release.


ODYS is working with A.R. Phoenix Resources Inc., Dr. Alton to select a group
of flexible curriculum to use with our youth in order to better meet their
individual needs. The curriculum will be administered on a dosage basis which
means that we can create program tracks that would benefit youth of all risk
levels, lengths of stay and need. We anticipate training on the new curriculum to
begin in 2008.


An intensive adolescent recovery substance abuse program has begun for female
youth at Scioto Juvenile Correctional Facility.


In 2005 the OSU contract for psychiatry was expanded to include all of ODYS’
central Ohio facilities.


Contract negotiations with OSU to formalize the process for inpatient psychiatric
services has led to a contract, which is anticipated to go into effect January 15,
2008. Our team did not review this contract.


A psychology position has been added to Scioto, specifically to assist with the
mental health unit.


All psychology assistants are masters trained clinicians.

• Beginning in October 2005, following extensive discussion with the union,
requirements for clinical positions have been enhanced. Since 2005, the number
of licensed social workers has nearly doubled from 26 to 50.

Policy has been developed to address restraint use on the mentally ill population
and staff are now being trained on restraint techniques from the National
Technical Assistant Center (NTAC). All training officers have been trained on
the new techniques by a nurse administrator.


A mental health database is being created to monitor and share information.


• Comfort rooms are being designed for use by youth on mental health units. These
rooms, or designated areas, will provide some degree of privacy and quiet where
youth can explore the use of many sensory items to assist them in managing stress
and developing coping strategies. The rooms are to be painted in serene tones and
stocked with items that engage the senses such as video rockers, weighted
blankets, stress balls, bean bags, and music which can be used by the youth while
in the room.

General population units are also to be changed and to become less punitive and
more normalized by including couches, rugs, richer colors and plant life.


Approximately 150 leisure reading books (i.e. Harry Potter and Chicken Soup for
Kids) are now available in nearly every housing unit in each DYS institution.

• Given the difficulty of all state agencies to recruit psychologist and even greater
difficulty in finding adolescent and child trained psychologists ODYS is
enhancing its effort in the hiring and recruitment of mental health professionals to
include the following:
o ODYS participated in the Child and Adolescent Psychiatry Services Task
force to review and determine creative ways of dealing with the issue of a
significant deficit locally and nationally of child and adolescent
o Partnered with the Ohio Psychological Association to assist in recruiting
o Expansion of the psychiatry contract for OSU.
o Development and continuation of a social work internship program with
The Ohio State University School of Social Work
o Development of an Internship/Postdoctoral program with Marshall
University at ORVJCF
o Another postdoctoral program is planned with Wright State University
School of Professional Psychology for the Central Ohio Facilities
o A new bureau chief with background in residential mental health was
hired in December 2007.
o A psychiatrist has been identified for ORVJCF and will begin providing
20 to 40 hours per week in January 2008
o ODYS has created one SW 3 position for each IMHU that requires a
master’s level social worker with a license (LISW) or Professional
Clinical Counselor (PCC)



The vast majority of juvenile sex offenders (97%) that are processed through
reception at Scioto have been adjudicated on a sexual offense. These youth represent
about one-fifth (21%) of all the youth in the custody of DYS.
At the time of expert Dr. Robert Prentky’s visits to Ohio (Sept. 21, 22, and 23)
that amounted to some 384 youth designated as sex offenders in the system with 139 of
them assigned as “High Needs,” 70 as “Moderate Needs,” and 30 as “Low Needs.” Of
the total of 384 juveniles designated as sex offenders, there were 145 youth still in the
custody of DYS but not in any sex offender programming.
Of the 239 remaining in sex offender programming, 58% were classified as High
Needs. Although bed space is a placement issue, staff asserted that bed availability is not
an issue with respect to need classification. Assessment staff stated to Dr. Prentky, “We
don’t even know what beds are available. We see the worst of the worst, so the fact that
60% are High Needs is no surprise.”
Before proceeding to an account of the expert review on our behalf by Dr.
Prentky, a few cautionary words by this writer are in order. First, and perhaps foremost,
the terms “sex offender,” “sexual psychopath,” “sexual predator, “ and “sexually
dangerous” are not clinically valid terms. 23 This means, in part, that there is no
constitutional right to treatment based on the disease model that underpins the Eighth
Amendment’s or Fourteenth Amendment’s right to treatment.
The normative terms listed above do not tell us anything about treatment needs,
they do not allow us to distinguish offenders based on the nature of the offense, and they
say virtually nothing about risk. The unitary terms such as sex offender or sex
psychopath tells us much more about the purveyor than the offender. Their use reflects a
normative stance that juveniles (and adults) who engage in criminally forbidden, sexually
related conduct should be singled out for special attention, perhaps for special
programming, and for post-adjudication or post-conviction registration that may last a


See Fred Cohen, Right to Treatment in the Sex Offender: Corrections, Treatment, and Legal Practice 241, 24-3 (Barbara K. Schwartz & Henry R. Cellini, ed’s., 1995)(Hereafter, Cohen, “Treatment.”)


A moral judgment about the nature of an offense or the offender is distinct from a
reasonable basis for treatment and a reasoned fear of recidivism. Franklin E. Zimring in
An American Travesty: Legal Responses to Adolescent Sexual Offending 67 (2004)
The 15000 children and adolescents under eighteen years of age arrested
for sex crimes each year are a heterogeneous group in terms of their
offense severity, their risk of future sexual misconduct, and their degree of
psychological pathology. The great majority of youthful sex offenders are
unlikely to re-offend, and are not suffering from extensive clinical
disabilities. But the few thousand juveniles who are arrested, in contrast
to the millions who commit sex crimes, are often involved in behavior that
harms people, usually children and adolescents. The palpable harm
caused by many juvenile sex offenders requires an official response. The
low risk of future sexual misconduct and the low likelihood of serious
sexual pathology argue against life-altering interventions and permanent
classification in stigmatic categories as routine responses to adolescent
sexual misconduct.
The legal issue within this litigation is not a demand for treatment based on sex
offender designation. Ohio law and policy, offering mandated treatment or programming
is well within the boundaries of legal acceptability but is at the perimeter — and beyond
— on the effective use of treatment resources.
We may presume that some juvenile sex offenders have a legitimate, diagnosable
mental illness — Professor Zimring estimates that fewer than 10% of U.S. juveniles
arrested show any sign of paraphilia 24 — and that group, of course, should be treated.
Using Professor Zimring’s estimate, for Ohio it may men that some 350 youth received
either inappropriate or unneeded treatment or programming.
As for dangerousness or the risk of recidivism, it should be noted that we do not
know what proportion of the population of chronic sex offenders have juvenile sex
offender records. The few studies on point are not conclusive. Variables that predict


Franklin E. Zimring, An American Travesty: Legal Responses to Adolescent Sexual Offending 64 (2004)


high recidivism in adult male offenders, youth and being unmarried, of course, do not
work with a population that is all young and single.
Caldwell’s analysis of ten studies on point produced no consistent pattern. 25 Only
a few studies even try to identify factors that distinguish juvenile reoffenders from those
who do not and the few studies published have conflicting results.
Dr. Robert Prentky, a nationally renowned figure in the field, was retained to
assess the Ohio DYS sex offender assessment and treatment program simply because of
the emphasis given to it and the resources expended for such care. I adhere to my earlier
cautions about the false premises of current policy regarding both the need for treatment
and the supposed distinctive threat posed by juvenile sexual misconduct.
At the same time, I reaffirm the desirability of evaluating the Ohio program on its
own terms and to that end Dr. Prentky is to be commended for he report he prepared for
this investigation.
Dr. Prentky is one of the developers of the assessment protocol used in Ohio to
assign sex offender “Needs” assessments. In his Report to me of October 15, 2007, Dr.
Prentky writes:
Although it was never clear to me precisely how Need classifications are
made, the decision appears to hinge on the Juvenile-Sex Offender
Assessment Protocol (J-SOAP), a risk assessment instrument development
by Prentky & Righthand (2003) for male sex offenders in age range of 12
to 18. Several “J-SOAP social workers,” trained by Dr. Righthand,
complete the J-SOAP while the youth are at Scioto. Although the J-SOAP
assesses risk, it has no cut-off scores for degree of risk. Since Dr.
Righthand, in her trainings, is typically adamant that ranges (i.e., Hi,
Mod., or Low) not be invented by users and that the J-SOAP should be
thought of as a “needs assessment” as much as a risk assessment, it
appears that the staff have avoided the use of the word “risk” in favor of


M.F. Caldwell, What We Do Not Know About Juvenile Sexual Reoffense Risk, 7 Child Maltreatment
291-302 (2002), we do know that sex offender recidivism is low in the teen years.


I requested and received a copy of a J-SOAP-II Report. The first 3 pages
of the 4-page report include the Reason for Referral, Presenting Problem,
Sources of Information, Family History, Prior Criminal History, Sexual
History, Social History, and Impression and Recommendations. On page
4, at the end of Impressions and Recommendations, the J-SOAP scores are
listed, followed by Program Recommendations: High Needs. In the final
paragraph, entitled Summarize Criteria for Program Recommendations, it
is stated that, “John is appropriate for High Needs Sex Offender
Programming for the following reasons: 1. Time frame of sexual
offending was more than 6 months, 2. Poor management of Sexual Urges,
3. Multiple types and acts of delinquent behavior, 4. Poor socialization
skills, and 5. Poor management of anger.” In-other-words, there is no
reference to the J-SOAP in justifying classification of High Needs.
Rather, there are five factors that are listed to explain the classification.
This three-tier system of classification is needlessly confusing, since the
use of terms like “High, Moderate, & Low” clearly impart the notion of
risk, whether the word Needs is substituted or not. Confusion arises from
the fact that there is no clear “line in the sand” marking the boundaries of
the three groups, or the precise procedure for placing kids into each of the
groups. The J-SOAP-II, a risk assessment scale, is integral to the intake
process, but it is unclear how the results are utilized. When directly asked
what a High Needs youth “looks like” compared to a Low Needs youth, I
was told that High Needs kids have (a) 3 or more victims, (b) duration of
offending that lasts 12 months or longer, (c) preoccupation with deviant
sexual themes, (d) a history of having been sexually or physically abused,
and (e) excessive aggression. By contrast, a Low Needs youth would have
the following profile: (a) only 1 victim, (b) no weapon used, (c) 3 or less
incidents, (d) duration of offending that lasts less than 6 months, (e) JSOAP scale 1-3 scores, (f) level of aggression (instrumental v. gratuitous)
and (g) clinical decision. If there is a structured, uniformly-applied,
operational procedure for rendering classifications, this appears to be it.


Ultimately, it appears that classification to High, Moderate, or Low groups
is what might be called research informed clinical judgment. All of the
items listed above appear on the J-SOAP. Thus, it appears that a clinical
decision was made to select a few of them for determining classification.
It is not clear how, if at all, the J-SOAP scale scores are factored into these
decisions. Although the hand full of items listed above can be used for
this screening purpose, their use can not be left to individualized
judgment. In- other-words, all of these items would require precise
operationalization (i.e., how do we determine “excessive” aggression or
“level” of aggression or “preoccupation with deviant sexual themes”?).
Staff raised a “regional” problem. Youth from Cleveland arrive with a
risk assessment already having been done and all are “high risk.” By
contrast, youth from other parts of the State arrive with no risk assessment.
Dr. Prentky’s concerns in other words, are with the selective and individualized
use of J-SOAP classification factors as a means to assign need (or risk). He obviously
does not challenge the validity of the instrument itself, only its haphazard use. Some
might challenge the instrument’s utility for risk assessment itself and argue for clinical
assessment of a diagnosable mental illness with the youth’s crime or crimes an important
factor in such diagnosis.
Dr. Prentky goes on to recommend change here:
Recommendation: Many of these classification problems can be shed by
using a system that is transparent, simple, workable, and that places a
minimal burden on risk assessment. A simple breakdown would separate
these youth into: A. Standard Programming, B. Special Needs (i.e., those
presently housed in Ash at Circleville, and C. Low Risk. This eliminates
the most difficult, and arguably indefensible, distinction between “High”
and “Moderate” risk offenders. They would all be provided Standard
Programming. The only distinctions that would have to made, and for
which explicit criteria would be required, would be assignments to either
a Special Needs unit (i.e., those kids with severe developmental, social or
cognitive deficits or a major psychiatric disorder) or to a Low Risk


placement (e.g., those kids with a single, isolated offense and an otherwise
benign history). This type of categorization does not avoid entirely the
issue of risk. It addresses risk in a way that is both programmatically
meaningful (separating out those kids that do not need and are unlikely to
benefit from intensive sex offender specific treatment) and
psychometrically reliable (i.e., classifying the lowest risk kids is
something that we can do reliably).
What follows are verbatim excerpts from Dr. Prentky’s report to me with
particular emphasis on Circleville, which is the focal point of Ohio DYS’s sex offender
Assessment Protocol at Scioto
The social work staff complete the J-SOAP and Hoge & Andrews’ Youth
Level of Service / Case Management Inventory. Data for completion of
these two tests come from the records and an interview. These results are
used to inform treatment planning. In addition, a PREA scale is used to
screen out youth that may be particularly vulnerable to sexual assault
within the population. This scale is a product from research spawned by
the 2003 Federal Prison Rape Elimination Act. A substance abuse
screening is done using the JASAE (Juvenile Automated Substance Abuse
Evaluation), a computer-assisted evaluation developed by Bryan Ellis. In
addition, the Massachusetts Youth Screening Instrument (MAYSI),
developed by Grisso and Barnum, is completed.
Recommendations: The existing protocol is fine. I would complement
it, however, with a number of additional structured questionnaires that
elicit feedback around targets areas of great concern: (a) a detailed abuse /
maltreatment history that asks not simply about the presence of a history
of sexual abuse (as one example) but about all morbidity factors
associated with the abuse, including a complete chronology of caregivers,
(b) Briere’s Trauma Symptom Checklist for Children / Trauma Symptom
Inventory – depending on the age of the youth; evaluating current signs
and symptoms associated with abuse-related trauma is critical for


informed decisions about treatment, (c) a comprehensive, structured
sexual history inventory, (d) one of several good questionnaires that have
been developed for adolescents to assess the experience, intensity, and
control / management of angry feelings, and (e) neuropsychological
screening that briefly assesses neurocognitive deficits, including
functional reading ability and comprehension. All of these areas of
assessment are essential for developing an informed, tailored plan that
treats all facets of a youngster’s functioning.
Availability of resources must be addressed. I heard the issue of resources
raised many times by staff. Ms. Williams, social work supervisor for
males at Scioto, observed that the number of youth arriving at Scioto has
tripled, from an average of 2-3/month to a current average of 10 / month.
This past July, the intake was 16. Another staff member commented that,
“As you draw up the census, you must draw up the resources. This has
not happened.” Adding the above suggested testing places the greatest
time demand on the youth themselves, with the obvious exception of
neurocognitive testing. I would estimate an additional 3 hours of time for
each youngster, plus an additional 1-2 hours for a supervised, MA-level
psychologist. Realistically, the additional required resources would be
another MA-level psychologist who is capable of administering and
interpreting neurocognitive tests for adolescents, and the purchase fees for
the tests themselves.
Circleville Visit
As noted, I spent two full days at the Circleville Juvenile Correctional
Facility. I met with Thomas Teague (Superintendent), Rose Harmon
(Executive Assistant to the Superintendent), Larry Alessio (Deputy
Superintendent and Director of Security), “Doc” Blackburn (Deputy
Superintendent for Finance), Linda Gable (Sex Offender Coordinator),
Trecia Holdren (Social Work Supervisor), and Dr. Barbara Scott Johnson.
I also met privately with several groups of youngsters representing both
the middle age (14-16) and older (17-19) kids, and separately with their


unit therapists. In addition, I met with a range of line therapists and
clinicians (e.g., Mr. Smith, Dr. Lagregory, Ms. Brisbine, Dr. Garbrecht).
Although the census ranges from 144 to 156, at the time I was there, the
census was “down” (133). There are six housing units with 24 beds on
each unit, except for Ash, which has 20 beds. There are two housing units
per building: Ash + Elm; Oak + Walnut; Hickory + Maple. The first two
buildings (Ash & Elm and Oak & Walnut) have three social workers each
and Hickory & Maple has four social workers. Hence, the resident to
therapist ratio ranges from 12:1 on Hickory & Maple to 16:1 on Oak &
Walnut. In addition to the ten social workers assigned to the units, there
are four psychologists (two doctoral-level and two Masters-level) who
provide “roving” services, as requested, to the residents at large.
Psychiatric services are contracted out to Ohio State University.
The program at Circleville has three phases. Each phase is described in a
detailed 3-ring binder of information that was made available to me. The
phases, simply stated, are 1. Informational, 2. Offense/Cycle, & 3. Relapse
Prevention Plan. Advancing from one phase to another involves a posttest as well as appearance before a transition panel. The passing score on
the test to move to the next phase is 70-75%. Phase III takes, on average
4-6 months to complete, though some motivated kids can complete it in 34 months. The entire program is designed to be completed in 12-18
months, though youngsters, if sufficiently motivated, can complete the
program in 12 months. Ordinarily, movement through the various levels
of a program, from point of entry to pre-release, is clearly explicated, with
concrete goals and objectives for each phase and transitions that routinely
follow completion of those goals and objectives. Those goals and
objectives must be clearly understood by the kids.
Recommendation: The psychotherapeutic component of the program is
consistent with what is provided elsewhere for juvenile sex offenders. It


appears to be well thought out and appropriately implemented. I would
only recommend, because of its obvious importance, that the goals and
objectives at each phase be addressed with each youngster in group or
individually and that the youngster be required to state in his own words
what is required of him. The only aspect of the therapeutic part of
programming that is neglected is childhood abuse and trauma. I spoke
with Dr. Garbrecht, who runs SOS groups. Survivors of Sexual Abuse
(SOS) is a time-limited (10-11 weeks), voluntary process group that
includes a manual and homework. The group is provided to very few kids
and requires a sexual abuse history. Everyone who comes to Circleville
should be evaluated for childhood history of abuse and trauma of any kind
and provided, if deemed appropriate, intensive, focal treatment for their
abuse. In addition to appropriate screening (e.g., the TSCC) and process
groups, the facility should have at least one FT trained trauma therapist on
staff who can recognize symptoms associated with post-traumatic stress
disorder and is skilled at treating it (including EMDR).
Privilege System
The privilege system has three levels: Basic, Additional, and Exceptional.
I requested and received a print out of the privilege assignments. Of the
132 kids assigned with privilege status, 37.9% were Basic, 25% were
Additional, and 37% were Exceptional. Facility wide, 37% assigned to
the highest level of privilege is not unreasonable. If one looks at the
breakdown by living unit, however, it is again noteworthy that Ash (and
Hickory) have the lowest proportion of kids (22% & 19% respectively)
with Exceptional privilege status. By contrast, Elm, Maple, Oak, and
Walnut have between 40% - 50% of their kids with Exceptional privilege
Perhaps the more meaningful question, however, is the effectiveness of the
privilege system. All youngsters that I spoke with who had anything to
say about the privileges available to them uniformly reported that the


privileges were trivial and effectively meaningless as external motivators
to do their work. It is easy to generate numerous examples of highly
coveted rewards for teenage boys, including a recreation room with music,
television or a movie-dedicated screen, pool table, etc; wider range of
choices of movies, including excellent educational movies that can be
serve a dual psychotherapeutic role; a wider range of channels that can be
accessed on their living unit TVs; a commissary with a much wider range
of sought after products; their own kitchen and the opportunity to prepare
their own meals (again, doubling as a practical life skill / training);
teenage-friendly meals in the cafeteria, such as pizza and hamburgers, and
access to therapeutic community programs.
Recommendation: Because of the potential power of such privileges as
motivators, as well as vehicles for skill-building and therapy, I recommend
that an entire building be designated as Exceptional privilege. Each
building has 48 beds in total. Excluding Ash, there are already 45 kids
classified as Exceptional. They could be placed in one building and that
building converted into a therapeutic community with many of the abovementioned privileges provided. The goal should be to convert all units
into therapeutic communities and strive to have two-thirds of the kids at
Exceptional privilege status.
Therapist Contact Time
The prison or institution-based treatment programs that I am acquainted
expect, in some cases require, anywhere from 15 to 20 hours/wk of
clinical contact time for therapists. This means that roughly half of the
therapist’s time is spent engaged in contact with the kids (e.g., running
process groups, facilitating “house” or therapeutic community meetings,
teaching psychoeducational classes, participating in therapy progress
review panels or committees, tutoring those taking psychoeducational
classes, doing individual behavior therapy, etc.). I was disturbed by
comments from some of the kids about the unavailability of clinicians. A


boy stated, “Some kids will go on suicide watch just for someone to pay
attention to you and talk to you.”
Recommendation: Clinicians should be required to log their clinical
contact time and demonstrate, as noted above, a minimum of 15-20 hours /
week providing direct service.
Release consists of four elements: 1. completing the “judge’s time” (the
minimum to serve time given at adjudication), 2. completing all 3 phases
of the program, 3. availability of a placement, and 4. a staffing. Staffing,
which occurs toward the end or at the end of Phase II, take place at the
DYS Regional Office. In addition to a member of the Release Authority in
DYS Central Office and a parole officer and placement coordinator from
the appropriate parole region, staffing may include a victim services
coordinator, the assigned social worker, and parents or guardians.
The Release Plan requires many tasks: 1. linking up with therapy and
medication in the community, 2. appropriate housing, 3. job placement, 4.
obtaining a copy of one’s birth certificate, 5. setting up MR / DD services,
if applicable, 6. obtaining a Medical / Medicaid card, if eligible, 7.
obtaining a State ID, 8. obtaining a Social Security card, 9. submitting
paperwork for SSI / SSDI, if eligible, 10. obtaining a Learner’s Permit
from the DMV, if eligible, and 11. arranging for services from the Bureau
of Vocational Rehabilitation. Although Re-entry teams from the
community (mentors) visit the facility, most of this work is done off-site at
DYS Regional Office.
Recommendation: This entire process appears to be needlessly
cumbersome. I recommend that this entire process be accomplished “in
house” (at the facility) and orchestrated by a release team at Circleville
with the explicit mission of facilitating and streamlining a smooth return
and optimally healthy readjustment in the community. It is the
youngster’s life that is being pieced together. He deserves to be integrally
involved at every step in designing this plan. It should not be done “from


afar” and then handed to him as a fait accompli. The bridge from prison
back to society must be erected jointly and paved as smoothly and as
sensitively (to the needs of the youth) as possible. Additionally, the JSOAP does not appear to be part of this release process. Since it is
administered at the beginning, it would make sense to re-administer it
(Scales 3 & 4) at the end. Overall, it did not seem as though the J-SOAP
was being used in any programmatic way that warranted its inclusion.
Staff Training and Supervision
Therapists complained to me about the lack of staff training. Apparently,
all staff receive a 3 week “pre-service” designed for everyone (i.e., the
training is not around therapy). In addition, there is a one-week in-service
every year for clinical staff. Several clinicians stated, in no uncertain
terms, that this was not adequate and that they often felt that they did not
know what they were doing.
Clinical supervision is extraordinarily important in a program such as this,
not only because of the challenging nature of the individuals being treated
but because of the often disturbing material that comes up in therapy and
the conditions under which treatment takes place. A high priority should
be placed on good staff supervision, not only to improve the quality of
treatment provided but to protect clinicians from burn out.
Recommendation: All clinicians hired to treat kids at Circleville must be
minimally prepared at the outset, reaching at least minimal best-practice
standards. Therapists should be well grounded not merely in the mode of
treatment (cognitive-behavior therapy), but in boundaries, sensitivity (i.e.,
sensitivity training), normal adolescent development, normal sexuality,
and degrees of deviant sexuality. With regard to supervision, I recommend
that all therapists have one hour of supervision each week, as well as
participating in a supervision group once a week or once every two weeks.
I would also recommend that non-therapy staff also be afforded
supervision, though on a less frequent basis. The therapists should be


viewed as change agents, and, as such, the efficacy of the program hinges,
in part, on their competence, if not their expertise.
[End Prentky Report]

Finally, to the extent that DYS wishes to rethink the extent of its commitment to
the current sex offender treatment program, I would suggest that any Settlement in this
proceeding include a provision requiring a study of the adjudication and disposition of
first-time sex offenders; the presence of sexual paraphilia in the sentenced sex offender
population, and the accuracy of assessments of dangerousness for that same population.
Ultimately, the questions should be whether those juveniles who are truly dangerous are
properly dealt with; are those who need, or would benefit from, treatment receiving it;
and may those without a clinical diagnosis requiring treatment be released from current
treatment-program obligations.



What follows, with a few editorial massages, is the summary of the full report
entitled, Review of Education Programs Provided to Juvenile Offenders in Ohio
Department of Youth Services Juvenile Correctional Facilities, which is appended as part
of Appendix D. This obviously is less than the full report and more than the executive
summary attached to it.
You will find Ava Crow’s summary unsettling, even disheartening. With the
exception of kudos for the new Superintendent, there’s not much here to provide comfort
for readers looking to grasp something positive.
The formula for education in DYS appears to be: Those with the greatest need,
receive the least help. There are deficits in teaching staff, failure to comply with state and
federal laws on point, limited space, and limited help with vocational training or postsecondary education opportunities.
Teachers are fearful and stress leave is all too common.
No one asserts that teaching these youth in what is a correctional, prison-like
setting is easy. Quite the contrary. However, as the “Crow Report” depressingly shows,
those with the greatest need continue to be to those with the greatest need.
The full Report is compelling, perhaps mandatory, reading for everyone involved
in this litigation. The Summary, which follows, is a must:
Leadership and Organizational Structure
“Education programs in juvenile correctional facilities are the key
factor in assuring that students have the tools needed for successful
transition back into the community…Studies have shown that the potential
for recommitment drops when students in juvenile correctional facilities
seriously address their education needs.” 26 “Education is an essential
component of treatment and rehabilitation for incarcerated youth and is the
foundation for programming in many juvenile institutions (citation
omitted). Helping youth acquire educational skills is one of the most


John Stewart, Ed.D, A Special Edition on Education Programs in Juvenile Correctional Facilities 53
Journal of Correctional Education #2, (6/02).


effective approaches to the…reduction of recidivism…Higher levels of
literacy are associated with lower (rates of) juvenile delinquency, rearrest
and recidivism.” 27
Education, historically a local concern, has become much more
“federalized.” No Child Left Behind (NCLB), an omnibus education
statute, and the Individuals with Disabilities Education Act (IDEA) require
that educators apply science, rather than instinct, to their teaching.
Education is now a scientific profession, and requires the leadership of
education professionals. 28 By hiring a new energetic school
superintendent, DYS has taken an important step in moving the school
district forward, but it has a long way to go. Using NCLB data, the district
is designated by the Ohio Department of Education as “in Academic
Emergency.” 29 To transform this school district into an effective
educational agency, the new Superintendent will need much assistance,
and DYS must make substantial changes in its organizational structure and
management style. 30
DYS has a “top down” management style that allows some
important educational decisions to be made without input from the Bureau
or school staff. Information was received that school officials were not
consulted in the decision to change from an eight period to a six period
day, but this is sharply denied by ODYS officials. School officials are
sharply divided on the merits of this decision but unified on its major
impact on the delivery of educational services. Regardless of which side


Peter E. Leone, Ph.D., Sheri M. Meisel, Will Drakeford Special Education Programs for Youth with
Disabilities in Juvenile Corrections 53 Journal of Correctional Education #2 (6/02).
The NCLB statute references “research” or “research based” more than 200 times. For example, local
school districts must assure the U. S. Department of Education that they will take into account “the findings
of relevant scientifically based research,” and that they will implement school wide reform strategies that
“use effective methods and instructional strategies that are based on scientifically based research.” IDEA
has similarly changed its focus to providing services based on science. “(S) Scientific, research-based
interventions may be used as a tool to identify specific learning disabilities. The students’ IEPs are to
contain “statement(s) of the (student’s)… services, based on peer-reviewed research to the extent
Department of Youth Services 2006-07 School Year Report Card,
See OAC 3301-30-01(B); 3301-35-11(C).


they may take, all believe that additional input from education officials
would have resulted in a better decision.
The non-inclusive nature of top down management extends to the
highest levels of DYS. Reportedly, Bureau administrators are involved
only by invitation in many agency-wide decisions that directly or
indirectly impact school services. For DYS to appropriately serve
students, it should ensure that the Superintendent be at every central office
meeting where decisions are being made that even tangentially touch on
The DYS organizational structure does not give the Bureau direct
authority to manage the schools. Despite statutory mandates, the school
superintendent does not assign school personnel or evaluate the school
principals. As a result, the Bureau has perhaps even less power with
individual schools than it has in Central Office. In some instances, there
are active efforts to circumvent Bureau directives. One Bureau
administrator, in talking about the schools, states, “I am just like a gnat
that they swat away.”
There is evidence of the truth of this statement. One principal, at
staff meetings is reported to say about Bureau directives, “This comes
from Columbus. They are only here six days a year, so we won’t worry
too much about this.” 31 In another example, in mid-August 2007, Bureau
administrators were alarmed to informally discover the existence of a
protective custody (PC) unit. Record review reveals that students had
been in this unit since at least July 5, 2007. At the time of discovery, 25
youth resided on this unit, 22 of whom were students, and 15 of whom


The principal denies this statement, noting that he understands how “things can be misperceived.”
However, a teacher very supportive of the principal, when asked about the statement, replied, “I won’t say
he hasn’t said it,” and continued by explaining that staff members were weary of directives from


require special education. Not one of these students was receiving
educational services until discovery by the Bureau. 32
In addition to the Bureau lacking authority, interviews establish
that institutional interests at the facilities sometimes impair efforts to
provide educational programming. If there is a conflict between providing
appropriate educational services for students and meeting other
institutional needs or preferences, the other institutional needs and
preferences prevail all too often. One example is at Luther Ball
(Cuyahoga) where space is at a premium and school administrators and
guidance counselors share offices. Two unit psychologists have private
offices located in the school’s administrative hall, and although there are
insufficient classrooms to offer additional electives, a large classroom was
taken over for medical services. Additionally a four-room module that
could be used to provide electives or special education is being used for
group. There are also two dorms that have been empty for an extended
period of time because of staffing and are currently being used as a game
room and for programming. One or both could be opened for career tech
classes or alternatively, used for some of the program offices and services
currently located in the school. Reportedly facility administrators are
contemplating changes, but at the time of the site visit, the situation was as
is reported.
In another example, the principal of a school was informed by the
facility superintendent that one of his best teachers should report to a
classroom that had been set up outside the school building for students on
unit restriction. Neither this principal nor any other educator had any
involvement in determining an appropriate way to educationally serve
these students, in creating this classroom, or in determining which teacher
would be most appropriate to handle an alternative classroom setting. No
consideration was given to the consequences to the school of moving this

Students on PC require a safety plan. Record review revealed that safety plans were written several days
to several weeks after the students had been placed in PC. For example, one student was place in PC on
July 5, yet his safety plan was not written until August 7, 2007, shortly before the site visit.


teacher out of the building. Although there is a new director and facility
superintendent, the original structure that allowed such a decision is still in
As a final organizational impediment, several principals reference
institutional responsibilities that detract from their instructional leadership
duties. These responsibilities include completing administrative duty
officer responsibilities, participating in training not directly related to
managing the school, conducting investigations and serving on
interdisciplinary committee hearings. While it may not be appropriate to
relieve school principals of all of these responsibilities, consideration
should be given to limiting them.
In sum, while DYS is to be commended for its ongoing efforts to
strengthen education, its organizational structure does not facilitate that
goal. Accountability cannot be established if the Bureau remains impotent
in addressing educational issues. If DYS schools are to ever successfully
measure achievement by the quantity of student learning, the Bureau must
be empowered and principals must function as instructional leaders.
While facility administrators need to maintain an ownership
interest in school services within their facilities, the Bureau of Education
must be in charge of education and be given oversight responsibilities for
the schools. Recommendations in the full education report are designed to
address these issues.
Full School Day and Staffing
DYS fails to meet its responsibilities as a “parent” under Ohio’s
compulsory attendance statute and fails to meet the statutory requirement
to provide a full school day. 33 Scioto River (Scioto reception for boys)
and the Freedom Center offer three hours or less of education to their

There is not agreement on what constitutes a full school day. DYS reports that its SOP providing, “The
school day…shall consist of scheduled classes, supervised activities or approved options for at least six
hours” means that schools must operate for six hours per day but does not provide an entitlement to
individual students for six hours of educational services. Even granting great deference to the agency in its
interpretation, OAC 3301-35-06 requires at least 5.5 hours of programming, and for this report, that figure
is used as the measure of a “full school day.”


students. On paper, it appears that all other DYS schools provide a full
school day for all students. In fact, that is not the case. Teacher shortages
are an overwhelming issue, and no DYS school is immune. Limited
classroom space and the logistics of providing unit instruction are also
major problems.
On a randomly selected, given day, through review of student
locators, 598 or 43% of DYS youth received less than a full day of school.
To demonstrate the impact on actual student lives one only needs to look
at the numbers revealed on the 8/14/07 Hickory Grove (Marion) student
locator report. Eleven students, mostly housed on unit six lost 100% of
their class time for three days, for a total of 66 missed classes. One
hundred and ten class periods were missed by 83 students for whom there
was no teacher on that particular day. These students lost 22% of their
class time on that day. And finally six students housed on the Marion
mental health unit were found to be getting only three 50-minute periods
per day; one half the number offered to other students.
Lack of a teacher or substitute is a common reason cited for loss of
class time. Teacher staffing is a chronic and debilitating concern. Twentythree teaching positions were reported vacant in August 2007. Some
schools report a chronic shortage of three to four teachers. At Luther Ball
(Cuyahoga), multiple classes were cancelled during a six-month period
due to teacher vacancies. At the time of the site visit, Hickory Grove
(Marion) had four teacher vacancies which included library, science,
English and special education. The English vacancy is especially
problematic since it has been open since December 2006. Two hundred of
the total 270 students are 9th and 10th graders, yet Hickory Grove has not
had an English teacher for these grades for eight calendar months. There
was no science class at Scioto River for a school term because of a
vacancy. The Starkey AOT class at Circleville did not meet for three
weeks because the teacher was in training. At Tecumseh (ORV) the short
staffing problem is reported to be cyclical. One guidance counselor


observes that the school is fully staffed from January to June and short
staffed from July to October or November because teachers leave for the
public school systems in June and it takes four to five months to replace
When substitutes are not available, librarians, guidance counselors
and assistant principals are pulled to cover classes. Additionally, special
education teachers are pulled out of their planning periods, and some are
pulled from their resource classrooms to cover general education classes.
These measures result in classes that are of questionable educational
value, in addition to having a detrimental effect on the overall operation of
the school. Despite these efforts, many classes must be cancelled due to
lack of sufficient staff. Rather than sending the students back to the unit,
some school administrators move the students to the library or in the case
of at least two schools, move them to a sterile holding room where no
educational activity occurs. In one hour at Hickory Grove at Marion, the
holding room census soared to 76 (40 graduates and 36 students). Not
surprisingly, the holding room was the scene of more than a few
disturbances. On a day at Indian River when four teachers were absent,
the shortage of substitutes necessitated one teacher’s class reporting to the
holding room throughout the day.
School administrators report that teacher stress contributes
dramatically to their inability to staff a full educational day. At more than
one school, principals explained that they fully expect teaching staff to use
all their leave days due the stressful working conditions, and some
teachers then obtain extended leave through the Family and Medical
Leave Act or unpaid leave. Assaults of teachers requiring hospital care
are not unusual at some of the facilities, and the stress and physical
injuries combined result in extensive teacher absences that must be
covered. School budgets do not cover the actual cost of necessary
substitute teachers.


An additional contributory factor causing short staffing is the
inordinate length of time from hiring to the actual day that a teacher
begins to teach. Principals estimate that the whole process of recruiting,
hiring, and pre-service training takes no less than three months and can
extend to five months. Education administrators point out that much of
the pre-service training is of limited relevance to school staff. Valuable
time spent in this orientation could be more effectively spent to meet
school staffing needs.
Lack of school space at some facilities is an additional contributory
factor in failing to provide all students with a full school day. Tecumseh at
ORV is currently almost 70 students over school capacity, meaning that
few, if any, students are receiving a full school day. An administrator at
Tecumseh explains, “We don’t physically have enough seats or teachers to
give everyone six classes (of 50 minutes each). If the number of classes
for any youth drops to four, he goes on a waiting list until he can get what
he needs. Right now there are 3 new youth on the waiting list who need
10th grade English. English is full. Four youth that came in July did not
have the necessary five classes 34 and they were also on the wait list.” The
new classification system continues to overload Tecumseh at ORV and
Hickory Grove at Marion, contributing to a decreased school day at each
Students with challenges such as mental illness or severe behavior
problems are often housed on specialty units or in isolation. The
educational experience for many of these students often consists of no
more than a worksheet slipped under a locked cell door. By even the most
optimistic estimates, the educational day on these isolation units does not
come close to meeting the requirement of a full school day.
There are occasions when even token education does not occur for
students in isolation or on the units. Hickory Grove (Marion) students lost


This official believes that 250 minutes of instruction is the minimum requirement. As discussed at Note
8, it appears that the law requires at least 5.5 hours of instruction.


3,725 hours of education in a school quarter because of students being
placed in isolation. In addition, the students in the Marion mental health
unit receive only three hours of instruction per day, and this is decreased
when the special education teacher is pulled to cover general education
classrooms. At Luther Ball at Cuyahoga Hills seven students have Special
Management Plans (SMPs) that require them to remain on the unit, usually
for five days, with school work dropped off. To the extent there is any
“instruction,” it is provided by a JCO. At Tecumseh (ORV), 18 students
housed in the Grant Unit receive only four classes per day.
“The education of our youth is intimately tied to crime and
delinquency rates.” 35 Since it is likely that many or all DYS officials
would unequivocally agree with this statement, it is incomprehensible that
these same officials would tolerate anything less than a full day of school
for all the youth entrusted to their care.
Special Education
The current version of the federal special education statute, the
Individuals with Disabilities Education Improvement Act of 2004 (IDEA),
reflects 30 years of pedagogical advances and refinements in the process
of providing educational services for students with disabilities. Over half
of DYS students are protected under this statute, yet teachers often view
IDEA as yet another paperwork burden. Minimal regard is given to the
substantive provisions of the statute. This view and the antecedent failure
to fully implement Individualized Education Programs (IEPs) are two of
the most disturbing facets of DYS non-compliance with the IDEA.
For the special education student to receive the benefit of the IEP,
the document must provided individualized services. All education
professionals must commit to implementation, to detailed monitoring of
progress, and to using the monitoring data to evaluate progress. Review of
IEPs and interviews with DYS teachers reveal that “special education” is
35 Marisa Ostroff, Ed.D., Educational Attainment and Delinquency: What Goes Up Brings the Other
Down 7 Juvenile Correctional Mental Health Report #2, p. 21 (Jan/Feb 2007).


almost solely limited to “extended time” and “small group instruction.”
These benefits are provided to all DYS students. Only a very few teachers
supplement these modifications or provide additional supplementary aids
and services in accordance with a truly individualized education plan. The
following comments by DYS teachers reflect the predominant attitudes
about special education:

At Indian River, a special education teacher states, “I don’t always go look
at the IEP when a student gets here. There are 8-10 coming and going
every month.” The teacher continues by noting that in teaching, “I shoot
for 3rd-4th grade level; you can’t individualize.” Regarding monitoring
data, a special education teacher states, “I ask the regular education
teachers, “What is he doing and how is his behavior,” and this information
is requested “only when a new IEP is due—I don’t have enough time to do
it any other time.” A general education teacher notes, “I think the special
education teachers spend a lot of time writing IEPs that do not get read.”


At Tecumseh (ORV), a general education teacher states, “I have never
been asked for progress on IEP goals.” Another general education teacher
states, “Progress may be general or specific.” A special education teacher
notes, “Probably now progress data is (sic) based more on lesson plans,
but we’re moving towards IEP goals.”


At Luther Ball (Cuyahoga), a special education teacher notes that there are
general education teachers “who don’t know their special education
students.” A general education teacher explains that he “didn’t typically
get IEPs,” doesn’t know if he can access them electronically and has never
been asked for progress data.


One particularly challenged general education teacher states that “generic
concepts” are taught in the class; noting that all youth “get the same folder
that is not on their level” because individualizing student work is too
difficult. This teacher notes that students will, from time to time, argue
about the work and what their IEP goals require, but the teacher explains
that it is simply too difficult to address these issues.



Another particularly challenged general education teacher, found in the
hallway, explained his presence by stating that a collaborating special
education teacher was currently with his class. He then stated that he
“didn’t really know if it was his class” noting that “the special education
teacher acted like it was her class, so maybe it was,” but he thought it was


Several general education teachers, although aware of their students’ IEPs
nevertheless teach those students from the class lesson plans. A couple of
these teachers note that they make sure their students “get their special
education—extra time to complete work and a small group.”
Another significant area of non-compliance relates to the federal
statute’s mandates related to behavior and changes of educational
placements. To shape student behavior, schools use SMPs rather than the
federally mandated behavior intervention plans based on functional
behavioral assessments. In clear violation of federal law, DYS IEP teams
never use the mandated procedures for disciplinary changes of placement.
At Tecumseh (ORV), school administrators or teachers make
placements into the Alternate Learning Center (ALC) for school-related
behavior. After 10 days of compliant behavior, the student returns to the
regular school setting, but if a YBIR is written within a specified period of
time, the student automatically returns to the ALC. Tecumseh is under the
misperception that placement in the ALC is not a “change of placement”
because the students’ general education teachers bring work over to the
ALC each period and the students remain on the general education
teachers’ class rolls. The teacher in the ALC is a highly qualified teacher
(HQT) special education teacher. While this situation presents a good
effort to stay within the change of placement rules without actually using
the required process, it does not comply with IDEA. In determining
whether the rules apply, the issue is whether the student’s learning
experiences are significantly changed. ALC students are forced to leave
the general education classrooms at the school building and move to a unit


classroom where their interactions are limited to the other students placed
there. They do not change classes and although a general education
teacher is present each class period, s/he is also serving the students in
individual cells, and the primary responsibility for instruction in the ALC
rests on the HQT special education teacher. The ALC is designed to be
more restrictive than the school building, and thus, by definition,
placement constitutes a ”change of placement.” Calling the ALC teacher a
collaborating teacher and leaving the students on the rolls of the general
education teachers do not change this fact.
Each “change of placement,” when accomplished for schoolrelated behavioral problems and cumulating to more than 10 days in a
school year is almost always an occasion when institutional correctional
policy is being used to override and violate federal education law.
Not only is the IEP team the sole “decider” of educational changes
of placement, if the change is a disciplinary change resulting from the
student’s behavior in the school, a specific process must be followed. This
process is designed to ensure that students not be excluded from the school
building for behavior related to their disability. Generally, a student cannot
be moved to a disciplinary educational placement for more than 10 days
unless an IEP team meeting is convened and a determination is made
about whether the student’s behavior in the school results from his
disability. The IEP team must consider the completion of a functional
behavioral assessment and a behavior intervention plan for the student. If
the IEP team determines that the student’s behavior is a manifestation of
the student’s disability, the student usually may not be suspended from the
school program for more than 10 days per school year; the student must
remain in or be returned to the educational setting where the behavior
occurred; and the student’s behavior must be addressed by modifying the
specially designed instruction and supplementary aids and services
provided to the student. The disciplinary changes of placement rules are
complicated, and a Flow Chart is attached as Appendix II to the full


education report. The only thing immediately crystal clear is that these
changes of placement decisions are education decisions to be made by IEP
teams and are not decisions to be made, as they now are, by facility
administration, IATs, treatment teams or psychologists. Although several
interviewees present persuasive reasons for the existing change of
placement practices, they nevertheless violate IDEA. DYS must address
these placement issues in a manner consistent with federal law.
The failure to provide students with individualized IEPs that are
collaboratively developed in IEP team meetings with appropriate members
present violates IDEA. The failure to teach to the IEP goals and the
failure to appropriately and accurately monitor progress violate IDEA.
The failure to use positive behavioral interventions in behavior
intervention plans and the failure to use the mandated procedures for
disciplinary changes of placement all violate IDEA.
Other major areas of non-compliance with the federal statute are
discussed in the full education report, and recommendations are made.
The DYS school system has made substantial progress in addressing
minimal legal compliance with some IDEA mandates. But to effectively
educate the special students protected by IDEA, partial compliance is
certainly not enough.
Instructional Practices and Discipline
The entire DYS school system struggles with the problem of
inconsistency in discipline. Effective teachers have far fewer discipline
referrals than the less effective teachers. Additionally, administrators
express frustration at the “quick trigger” of some teachers, who invariably
are the more challenged teachers. After seven weeks of an eight-week
grading period at Indian River, the number of In School Suspension (ISS)
referrals ranged from one to five for some teachers up to 60 and 70 for
others. The total of ISS referrals for those weeks was 917. The principal
of Luther Ball (Cuyahoga) related that four teachers call for help more


often than the rest of the combined teaching staff. These trends are
mirrored throughout the DYS system.
Administrators were asked to identify their most and least effective
teachers, and these teachers were then observed and/or interviewed. Those
identified as successful teachers issued the fewest YBIRs and ISS
referrals. These teachers followed detailed lesson plans and employed a
variety of methods to present the material to students. Their students were
engaged and appeared to be content.
The less effective teachers issued the most YBIRs and ISS
referrals. Their lesson plans often consisted of no more than a page
number and an assignment. These teachers were observed to have the
least amount of content in their lesson. The majority of these teachers
relied on individual seat work, with worksheets and little or no instruction.
In these situations, each student got his own folder and when he had a
question, he was to wait patiently until the teacher had time to help him.
This method delivered information to students who already understood the
subject matter. They were observed to work through the lesson in the first
20 or 30 minutes and then they finished and were ready to get into
mischief. For students who were having difficulty or appeared totally lost,
the experience was extremely frustrating. When help finally arrived, the
teacher frequently was observed to share a few words with the student
(often, the answer to the worksheet question, with minimal, if any,
instruction as to why it was the answer), and the teacher would then move
to the next student who was calling out or raising a hand. The student
often appeared to be as perplexed as before the “help” arrived.
Through its Character Counts program, DYS encourages the use of
positive reinforcement. However punitive actions far outnumber any
positive rewards. During the month of April, Indian River identified a
total of 766 violations and wrote only 49 Commendable Conduct reports.
In July 2007, Hickory Grove (Marion) reported 1323 violations while only
one Commendable Conduct report was written. Tecumseh (ORV) also


reported over 900 YBIRs in one month and a very small number of
Commendable Conduct reports.
Interviews with principals and review of professional evaluations
reveal that school administrators are fully aware of the ineffective
teachers. With some exceptions, principals utilize evaluations to put
teachers on notice of needed improvement. If quality instruction is to be
delivered to students, it is imperative that administrators’ focus
concentrated energy on improving the instructional practices of teachers
already identified as ineffective.
While school culture and classroom management skills have a
dramatic impact on student behavior, other institutional factors contribute
to the safety concerns of teachers. Chaos and unrest initiated in areas
outside the school were observed to carry over into the classroom, to the
detriment of all students. Sixty-two percent of all teachers express
dissatisfaction with school safety. 36 Interviews with staff reveal
widespread concern about the increasing prevalence of gang activity in the
student population. When questioned about the nature of the gang
activity, one assistant principal familiar with gang dynamics, explained
that the gang leaders remain in the background, giving assignments to
youth wishing to be identified with a certain gang. A typical assignment
may be to perform a “hit” on another youth. An especially competent
English teacher at Tecumseh (ORV) expressed her frustration at the
number of “hits” that occurred in her classroom in one month. Each of
these incidents occurred during hall movement when a fledgling gang
member would dart into her classroom and hit another student. The
teacher explained that when these disruptions occurred in her classroom,
the first ten minutes of the class were spent with the JCOs breaking up the
fight and cleaning up blood. She knew that the students would not be,
shall we say, quite as focused as she would like for the balance of the


Ohio Department of Youth Services, 2007 District Plan, 7.


class. Her experiences were not atypical of other incidents related by
school staff.
The prevalence of gang behavior is a growing concern that schools
cannot address alone. Realistically, a certain number of these incidents
will occur in a correctional facility, and will increase with overcrowding.
The new superintendent at Marion referenced the great need for a culture
change, and the Indian River superintendent states that they are working
on a culture change in her facility. It is critical that school and facility
staff coordinate and work together to solve this problem with structured
communication and cooperation between the schools and units.
Educational Assessment, Guidance Counseling & Reentry Services
DYS fails to adequately provide a system of academic and career
technical counseling and initial screening. Guidance counselors and
teachers report that standardized tests given at the reception center often
result in unreliable scores due to a number of factors related to emotional
and physical adjustment to incarceration. At least one school retests all of
its students because of the unreliability of the data received from Scioto
reception, and staff in several schools suggests that it would be more
reliable to test the students after they have had time to adjust to new
Counselors do not provide an adequate system of academic, career
technical and postsecondary counseling for students. If a student
approaches the guidance office with a request for guidance in any of these
areas, the counselors will assist the student, but there is no system in place
to inform students of these services, nor is there a systematic effort to
encourage students to seek postsecondary education.
Counselors cite time limitations as reasons for not fully performing
duties that are additional to scheduling and transcript issuance. In theory,
scheduling should become easier once the new computerized learning
system is functioning. However, this theory has yet to be tested. In the
meantime, two DYS schools have devised methods to extend the reach of


existing counselors. At Scioto reception, the TO provides that four
teachers, rather than guidance counselors, perform assessment duties
under the supervision of one guidance counselor. At Hickory Grove
(Marion) where the guidance position is vacant, these duties have been
performed by a teacher relieved of classroom duties and a permanent
substitute teacher under the supervision of an assistant principal. Adapting
these models, under the supervision of a guidance counselor, all DYS
schools could utilize competent administrative assistants, much like the
special education assistants, to perform technical duties. This would free
up guidance counselors to provide intensive counseling on career tech and
postsecondary issues.
The Bureau’s mission is to provide educational programs and
services to help students develop competencies necessary for successful
reentry into the community. However, funding for postsecondary options
has been removed; a counterproductive action that likely ensures that
achievers in the facility rise no higher. Additionally, opportunities that
were once available to selected students off-grounds, such as work
opportunities and even, at one facility after assiduous efforts by an AOT
teacher, a college visit, are no longer available. Reentry efforts are
additionally hampered by restrictions on intranet access for students who
are not able to access hometown newspapers to survey job and housing
options and are not able to access a wealth of information about
postsecondary options. All of these restrictions make successful reentry a
challenge for even the most motivated student.
There are creative ways to bridge transition to the community. The
Indian River AOT teacher brought postsecondary options into the school
by bringing in a nearby college class to complete a joint project with
students. This project culminated in program where every student, dressed
in a suit and tie, made a presentation to a group of more than 100 people.


Each participating DYS student obtained college credit for the work. 37
This effort should be replicated, and other facilities should be encouraged
to develop similar outreach efforts.
Career-Technical and Job Training
DYS convened a Job Skills Committee in 2007 which identified
the strengths and weaknesses of the career tech programs. The
recommendations of that committee do not go far enough to address the
lack of an effective career tech program in the DYS school system.
The vast majority of students do not receive systematic career
counseling. At reception, all youth take the career interest inventory
which helps the youth identify personal vocational interests and skills. The
results of this inventory resemble a wish list and do not provide a basis
upon which to individualize the educational plan for the youth. For many
students, the inventory will be helpful only if they are also provided
systematic academic and career technical counseling to assist in
developing realistic goals.
Career tech administrators acknowledge that there have been zero
completers of any of the two-year career tech classes “in several years.”
The administrator attributes this to the short terms of commitment for
DYS youth. This explanation ignores the substantial number of DYS
youth incarcerated for two years or more, none of whom has completed a
career tech program. The stated mission of DYS is to provide educational
programs to help youth successfully reenter their home communities. 38
Youth cannot achieve successful reentry without job skills.
Discussions with Bureau administrators about the career tech
programs reveal that some of the problems of the program are related to
the apparently inflexible requirements of the Ohio Department of


The college students working on the project wanted to provide gifts to the facility students at the end of
the project—the AOT teacher recommended dictionaries which, she noted, students will steal.
Interestingly, the assistant principal at Hickory Grove also provides rhyming dictionaries as rewards, noting
the students’ intense interest in these. There is a message here about students’ interest in learning.
Ohio Department of Youth Services, 2007 District Plan, 2.


Education (ODE), through which career tech programs are unit funded. A
frustrated career tech teacher shared this insight:
“In the public schools, virtually every DYS youth would be a
viable candidate for career tech. Youth with behavior problems that don’t
do well anywhere else often do well in career tech classes. Even the
smallest school should have career tech classes that are full. However,
current requirements related to funding units through ODE prevent this
from happening.”
Youth are placed in DYS according to security and treatment
needs. While there are several career tech offerings in the system, it is
only by happenstance that a youth’s placement will match his actual
interest and aptitude. For example, Indian River offers a strong auto body
repair class, but a student with aptitude for auto body repair may be
assigned to Luther Ball (Cuyahoga) where there is no class. Students with
aptitude for anything other than office technology have no substantive
options if placed at Luther Ball (Cuyahoga) or Willis (Scioto).
The classification system and ODE’s inflexible requirements are
not the only challenges to a robust career tech program. Each school has
numerous high school graduates and GED completers that would benefit
from attending career tech classes while also boosting the census of
endangered classes. However, ODE requires that a graduate or GED
completer take two additional classes when enrolling in career tech. This
requirement virtually eliminates the possibility that a youth in either of
these categories will opt for career tech preferring, instead, to sit in a
holding room or on the unit.
Another substantial road block to successful career tech
programming involves limited space. Space limitations play a significant
role in the electives that may be offered. Tecumseh (ORV) and Luther
Ball (Cuyahoga) are bursting at the seams with virtually every square inch
utilized. An annex at Tecumseh was planned to house additional career


tech offerings, but this facility has not materialized. Luther Ball has
empty dorms but they have not been converted to school space.
Educational Programs and Support
Several identified student populations are not receiving instruction
of high quality designed to meet their needs. One such group is the
students whose reading scores are so low as to result in their exclusion
from the Striving Readers (Read 180) grant awarded to DYS in March
2006. These are “beginning readers” and on October 30, 2007, they
comprised approximately 7% of the DYS population. Guidelines for Read
180 specifically exclude students whose reading scores label them
“beginning readers,” thus excluding the students with the most severe
reading deficits. Compounding the problem for these unfortunate students
is the decision at all schools except Indian River to convert Title I reading
positions to math. Therefore, students with the most severe need for
remedial reading are receiving the least amount of direct services—their
Title I reading services have been eliminated and they are excluded from
direct services in the Read 180 classrooms. 39 Although Bureau officials
believe that the mandated P.D. for all teachers under the reading grant will
improve reading in the general education classrooms, no evidence of that
was seen during observations. To make matters worse, it is reported that
the new computerized learning system will not have instructional software
to teach pre-literate students to read. Thus the students with the lowest
reading scores have no targeted direct programming to assist them in
learning to read, and no remedy is in sight.
This regulation is also not met for some other groups, including the
limited but growing number of 12- and 13-year-old students in the custody
of DYS. DYS has no middle school to serve these students. They are
sandwiched in to high school classes, sometimes with 20-year-old
students. These classes simply are not “appropriate to the students’ age

The elimination of the Title I reading teachers also negatively affects those students who are slightly
better than “beginning readers” but who are in the roughly 50% of students randomly selected to not
participate in Read 180.


(and) developmental needs.” The older, often toughened students become
the role models for these 12- and 13-year olds.
Physical Plant
Luther Ball at Cuyahoga, Tecumseh at ORV, and Scioto River
(boys’ reception) have classroom and office space problems. Luther Ball
at Cuyahoga Hills and Hickory Grove at Marion additionally have issues
impacting safety, and Luther Ball has sanitation concerns. These
problems interrelate with other challenges in the facilities, compounding
difficulties for staff and impairing the quality of education provided to
Luther Ball at Cuyahoga Hills is overcrowded. The lack of
classroom space limits the number of electives students can be offered,
negatively impacting student scheduling, student idleness, and educational
outcomes for students. Career tech classes are almost non-existent because
of lack of adequate space. At Indian River, students are placed in
classrooms, “based on wherever there is a seat.” Hickory Grove at Marion
uses its IAT to make educational placement decisions for students being
considered for placement in the mental health unit classroom, and it was
explained that if there are no seats, “we just don’t start up the IAT process
until there’s an open slot.”
Although reportedly shared space has now been found for the
contract Speech Language Pathologist (SLP) at Luther Ball, for months
she often had to hunt for a work space upon arrival. She reports that this
search for an area where she could work with a student could take as much
as half an hour each day she arrived. This is contract time that could
otherwise have been productively spent on student services. While school
space is occupied by non-educational staff and services, special education
classes are splitting a classroom, an assistant principal shares an office
with another staff person, two guidance counselors share a large room
with an administrative assistant, and special education teachers are sharing


work space with the SLP. All of these limitations negatively impact the
quality of youth learning.
Ceiling tiles are broken or missing in at least one classroom and
the ISS room at Luther Ball. Reportedly students have used the missing
tiles to attempt to crawl into the ceiling for whatever egress that might
give them. Despite requests extending more than ten weeks to repair these
tiles, they remain missing or broken. Additionally, there is a serious
bathroom issue at the school affecting facility conditions that impact
student learning.
A Scioto administrator notes that there is a “lack of space to
educate both boys and girls for a full school day; a lack of space to work
with students 1:1; a lack of space for administrative staff.” The Scioto
River (boys’ reception)) guidance counselor shares a cramped office with
a special education teacher and the school secretary. There is no space for
private conferences or telephone conversations. Finally, the most crucial
space limitation at Scioto River is that the shortage of classrooms limits
the students to only three hours of class per day.
Tecumseh at ORV is also suffering severe space limitations.
Common areas in the school, such as hallways, cannot expand to
accommodate the additional students that have arrived. During the site
visit, there were 240-260 students moving in the hall at any one time, and
there were 36 to 50 students per period who had no class because there are
insufficient numbers of classrooms and teachers. Since the site visit, the
classification system has resulted in even more students at Tecumseh, with
students now receiving even fewer classes.
During the Tecumseh visit at ORV, when the temperature was in
the high 80s and low 90s, an air conditioning unit was not functioning in
the building housing the Intensive Programming Unit (IPU) and the
Alternative Learning Center (ALC). Although fans were operating, they
were not reaching the individual cells nor were they serving the ALC. On
the next day, this air conditioning unit was still broken and the units


serving the school building proper were also down. By mid-afternoon, all
teachers had their doors open and there was discussion of canceling
classes. Tecumseh school officials report that this experience is not an
anomaly; there are frequent problems with both the air conditioning and
heating systems.
There are also security and safety issues at some schools. Within
the last few months, gang-related assaults on students have been reported
at Tecumseh (ORV) and Hickory Grove (Marion). Since January 2007,
student assaults on staff members have been reported at Hickory Grove
and Indian River and there may be additional incidents at these and other
DYS schools. Deficiencies exist in the security systems. There is a need
for security cameras. The man-down system at Hickory Grove at Marion
requires parts ordered from overseas. Thus, when it was hit by lightening
during the site visit, it could not be immediately repaired and teachers had
no classroom security.
The fire alarm cannot be heard in two classrooms at Luther Ball at
Cuyahoga, and the “man down” hardwired buttons on the walls do not
function in any of the classrooms. Staff members have radios, and the
principal explained that on occasions when they are short on radios, she
and/or the Program Deputy relinquish theirs. At the time of the site visit, a
work order had been in place for an extended period of time to fix the
doors to the gym. That had not happened, and students were popping the
doors open, contributing to already existing problems in gym class. 40
Supplements about the school programs at Marion, the Freedom
Center and Willis (the program for girls at Scioto) are attached to the full
education report. The Willis program is substantially improved from
2004. There are significant problems with the Freedom Center education
services. The school program at Marion also has serious problems, and


This class is substantially over cap because there are no other electives available. The class is already the
source of many, many behavioral issues without the complication of additional youth coming in and out.


many of the CRIPA issues identified by Dr. John Wills Lloyd’s September
26, 2005 report continue to be areas of great concern.
To supplement Dr. Lloyd’s findings:

Child Find efforts appear to be improved, but it is recommended that the
Bureau of Education continue to monitor this area.


Issues remain with IEP team membership and the collaborative drafting of


Significant issues remain with changes of educational placement to an
alternative learning center and to unit instruction; with individualization of
student services on IEPs and the monitoring of progress on IEP goals; with
the effective use of positive behavior interventions; with the use of
functional behavioral assessments and behavior intervention plans; and
with the quality of instruction and classroom management.


Dr. Lloyd expressed concerns about limited professional development
being made available in many of these areas. The Bureau and school have
made professional development available, but this has not ameliorated
many of the concerns it was apparently designed to address.
In sum, it will be a daunting task for the DYS school system to
bring itself into minimal compliance with federal and state law. It will
take organizational commitment, increased resources and focused energy.
Anything less will merely maintain the deficient status quo.
[End Crow Report]


Section VI, Education

Improving Education Opportunities

ODYS secured a 5 year $14 million grant from the U.S. Department of Education.
This grant allows us to provide intensive literacy intervention to a subset of our
population who are deficient at least two grade levels. This grant has also
provided DYS the opportunity to train our education professionals to infuse
literacy into every subject. The program is an intensive daily 90-minute class, in
which a group of 12-15 students rotate in to different stations for short blocks of
time. The stations include video software, student / teacher one-on-ones, audio
books and paperbacks to ensure that students, regardless of learning method, are
able to benefit.
ODYS will collaborate with the Ohio Department of Education to provide a
training curriculum for DYS instructors. The Ohio State University’s Center for
Learning Excellence will develop the research evaluation component of the
project. Since DYS was the only correctional system in the nation to apply for
this grant, the results of this study could be the benchmark for literacy programs
in juvenile justice systems nationwide.


All teaching positions in the ODYS school district requiring a Highly Qualified
Status are filled with teachers who are Highly Qualified in the subject matter
under the No Child Left Behind Act.


In 2008 the ODYS school district will move to provide individualized learning
environments for all youth via the student learning system. This web-based
program will allow each student to be assessed in all core academic areas and will
then design an individualized learning curriculum for each student. This will
allow each student to work at his or her individual ability level and allow the
district to accurately assess student progress. The program also provides the
potential for accelerated credit recovery, improving a youth’s chances at
achieving a diploma.


Submitted by ODYS to Fred Cohen on December 21, 2007. Fred Cohen excised some of this submission
and slightly edited other parts.



The general population juvenile correctional facilities (JCF) (IRVCF, MaJCF,
ORVJCF, and SJCF) are overcrowded. These facilities operated at 141% of rated
capacity on the dates of our assessments. Only the treatment-oriented facilities (Mohican
and Circleville) operated below rated capacity (see Roush Report, Table 2).
Research and experience indicate that there are no benefits and many liabilities to
youth or staff in crowded institutions. Indicators of safety and programming suffer
during periods of crowding, and this level of crowding is sufficient to have a clear and
negative effect on those indictors. Levels of crowding co-vary with the Performancebased Standards (PbS) measures of safety and program effectiveness (see Roush Report,
Table 3).
Expert David Roush asserts that overcrowding creates social density problems
associated with adverse effects that are particularly aggravated with children and youth.
When crowding or density increases, studies have found:

Decreases in the ability to classify and treat; incarceration becomes


Effects apply to not only residents but also staff.


Increases in the frequency and rate of disruptive behaviors; effects are
aggravated with juvenile and young adult offenders.


Decreases in residents’ perceptions of order, organization, and staff


Decreases in involvement with peers; decreases in classroom cooperation,
and lower school grades.


Decreases in perceptions of safety.


Increases in aggressive behaviors in boys; girls were unaffected.


Increases in the rates of social withdrawal, of avoidance of eye contact,
and of solitary play.


Increases in the rates of juvenile-on-staff injuries.


Increases in the rate of suicidal behaviors.


Increases in the rate of isolation (room confinement) less than 24 hours in


Increases in the rate of injury.

Overcrowding negatively affects privacy. For example, youth we spoke with
requested more supervision for the bathroom area. Because of double occupancy or a
doubling of the capacity, it takes longer to shower in the living unit, so several JCFs
modified the bathrooms to make more room for group showers which, in turn, impinge
on privacy. Additionally, there are no surveillance cameras in the bathrooms, and
residents state that the absence of cameras makes the bathroom dangerous.
The need for time-phasing or sharing of recreational space means that it is not
uncommon for groups or living units to participate in the large muscle exercise period
immediately following a meal. At two JCFs, the large muscle exercise (recreation)
occurred at 7:50 a.m.
The IJA-ABA, Juvenile Justice Standards: Corrections administration, Sec. 7.2
(1996), drafted in the early 1970’s, adopted the “smaller is better” philosophy and
promulgated a limitation on the size of residential facilities in the range of 12 to 20
occupants. Table 2 of the Roush Report describes rated and actual capacity for the
facilities visited.
The Boone Unit at Scioto was found to be 262% over capacity, Building 6, Unit
D at Marion was at 192% of capacity, and Aviation-Rickenbacker at ORV was at 205%
of capacity. Circleville had only one unit slightly above capacity because the facility
itself went from a two-person to a one-person celling arrangement in light of recent
When facilities are overcrowded and staff size is not adjusted accordingly, the
potential for exacerbating the negative consequences listed above increases dramatically.
At a certain point the crowding-harm to youth calculus is such that DYS violates its
constitutional obligation to provide youth with a safe environment.
Whether this Report speaks to education, mental health, or security, there is a
common thread to our findings: Staffing is inadequate. The normative term
“inadequate,” in turn, takes on meaning only in the context of the objectives to be


achieved. In this section, I will speak primarily of security and safety. Term member
David Roush, in his report, states bluntly, “DYS is severely understaffed at the JCO job
classification. Current staffing is below a basic level to ensure safety, order, and
This finding, of course, relates understaffing to violence: youth-on-youth and
staff-on-youth. The ripple effect of the JCO shortage reaches powerfully into what
appears to be the primary job irritant for the JCOs: the dreaded mandation.
I personally interviewed JCO, union representatives in each of the six facilities I
visited (25 people). Their chief complaint was being required to work mandatory
overtime. Marion JCOs represent that the average workweek for them includes 24 hours
or more of overtime per week.
I interviewed one JCO who took pride in working 80 hours for as long as he could
remember. He put two daughters through medical school by following this work
schedule. He did not complain about mandation nor did he distinguish to me mandated
overtime from voluntary overtime.
In Section V, discussing mental health issues, we noted that the JCOs function
primarily as custodial staff when they might be much more effective as a part of a
treatment-rehabilitation system and team. Their job descriptions would appear to support
the role of JCOs in facilitating group discussion and assisting youth in the development
of goals and acceptable social behavior.
The team found no evidence that JCOs accept or perform this more expansive
role, certainly not in any systematic fashion. However, even if the expanded role were to
be embraced it simply could not be performed with the current numbers of JCOs and
their educational background and training.
We were unable to acquire precise data on the incidence of mandated overtime.
However, we have sufficient confidence in the data and anecdotal material we do have to
describe mandation as a serious systemic problem in need of early resolution.
Additional JCO staffing, if done properly should enhance safety and security in
the facilities and also solve the most nagging problem as universally expressed by JCOs:
mandated overtime.


In analyzing JCO staff shortfalls, the investigative team strongly believes that it
would be a fundamental error to begin hiring JCOs without first reviewing and
determining what role, if any, there should be for JCOs beyond security and safety. An
expanded role for JCOs, in turn, would make sense in the context of a review and
possible reconstitution of the architecture and objectives of the agency itself.
Working within the framework of a safety and security mission, team member
David Roush asked: What is an appropriate staffing ratio? What follows is his approach
to answering that question. This is a difficult question because of multiple perspectives.
Roush referenced an Ohio ratio of 1:12, which may not be directly applicable here, as one
of his basis for estimating JCO needs. There is a real ratio based on current practices
(1:24). There is a ratio based on practitioner experience (1:10). There is a best practices
ratio derived from a review and summary of research and professional writings on the
topic of staff sufficiency (1:8).
Based on evidence acquired to date, the current DYS staffing patterns have been
able to accomplish only one of its affirmative duties, security. Perceptions of safety are
substantially low among residents and staff. Both express substantial levels of fear for
their personal safety (see Roush Report, Table 3). Over 60% of the teachers in the DYS
education system report that they fear for their safety.
The fiscally responsible staffing goal should be a DYS operation that is adequate
in numbers and possesses the skills necessary to do the job. “Adequate” means that the
staffing ratio (number youth per JCO staff) should be at the point where safety, security,
order, and programs operate effectively. The skill development function brings with it the
expectation that staff perform their job duties competently within a viable system that
provides quality leadership and supervision.)
The perspective on “adequate” staffing differs between the adult corrections and
the juvenile justice viewpoints. At the core are the differences with adolescent
development. From the adolescent perspectives (safety, security, order, and programs), an
adult corrections expert’s tour of the JCFs may prompt only a mild concern or comment
about inadequate staffing. However, from the juvenile justice expert’s perspective, the
same tour literally takes one’s breath away. Explaining the severity of the understaffing


to those with an adult corrections model prompts the use of exaggerated analogies and
The current staffing levels (Tables of Organization or Matrix staffing numbers)
likely derive from staffing estimates calculated on a ratio (1:12) when institutional
capacities were substantially less. Therefore, the alternative way of addressing the
staffing ratio without adding staff is to reduce the population of DYS institutions and
maintain the present “law and order” model.
JCO staffing levels now are so low that they likely covary with other indicators,
especially those that measure safety and bureaucratic dysfunction. This is the case when
comparing the staff shortage numbers per JCF with corresponding PbS measures of
safety and program outcomes. From a methodological perspective, caution is warranted
since support for bureaucratic dysfunction might simply be another measure of
inadequate staffing.
If the 1:12 ratio is used as the definition of “lean” staffing, will require 188 new
FTE JCO positions (not including those Matrix positions that are currently vacant) and an
increase in the personnel budget of $ 7.8 million annually based on a starting salary of
$15 per hour. (For the 1:10 ratio, the annual increase is $ 10.6 million and, for the 1:8
ratio, the annual increase is $ 14.2 million.) This remedy is expensive. Hence, a workable
alternative could be a plan that incrementally expands JCO staffing and responsibilities
while reducing institutional populations and increasing reliance on community resources.
This Report offers no firm recommendation on JCO staffing other than to assert
that current staffing under current conditions is too low. Settlement discussions might
focus on 90 new positions as a low and 188 as a high with a final number subject to
negotiation and the possibility of an objective post-settlement study.
Without addressing this issue, the JCOs will continue to struggle with the fallout
of mandation while security and safety will remain problematic.
Training differs from education in that training is focused on skills and task/job
performance. While there clearly may be some overlap, educational enterprises seek to
convey ways of thinking; acquisition of data; and broad, general concepts. Education is
to architecture what training is to carpentry.


Team member David Roush found no evidence of educational programs at the
Training Academy (TA) and had serious questions about the training program for DYS
The TA itself has excellent physical space, adequate training staff, and some
acceptable training materials. Evaluations of trainees, however, are too subjective. Due
to the shortages of JCOs, trainers work individually and prompt trainees on how to
answer post-test questions correctly, thereby increasing the numbers that pass the training
and move to the JCFs for work assignments.
Once a fledgling JCO completes the TA training and moves on to a JCF there will
be only one training officer who, in turn, must use fellow JCOs and other staff as trainers.
With 30 of the 40 hours of annual mandatory training prescribed by DYS, this leaves
litter time for facility-specific issue training.
A theme that emerged from the interviews with training officers was the concept
of “temporary proficiency.” Two training officers used the term when discussing physical
restraint training. Their belief was that most JCOs do not remember the Response-toResistance (R2R) protocols and techniques. Without an ongoing annual refresher course,
there contention was that staff have only a temporary proficiency in the approved
restraint strategy following the Pre-Service Academy. This, of course, was independently
described by team member Steve Martin.
On-the-job-training (OJT) is the main influence on JCO behavior according to
JCOs and training officers. It is correctional, custodial, and security-oriented; and it
reinforces the harsh staff climate in each JCF.
The OJT is an 80-hour process that reinforces most of the poor practices in the job
performance of JCOs. None of the training officers reported regular meetings with the
mentor JCOs to discuss, review, or evaluate the OJT process. Furthermore, training
officers indicated that they do not get training or guidance from DYS regarding OJT. No
one mentioned a recent meeting of training officers to discuss or evaluate OJT.
The system avoids information and concepts from the childcare and adolescent
perspectives. The heavy emphasis on the correctional aspects (security, staff safety, and
control) seems to preclude information about adolescence and the legal rights of juveniles
that could be helpful in altering behavior. This preoccupation creates a condition where


the absence of a broad-based training experience and the lack of openness to the
uniqueness of adolescence, combine to enforce the culture of violence we have observed.
As if moving lockstep with adult corrections, JCOs receive training and
information on STG (security threat groups) without clear differentiations with mental
health behaviors. To use Maslow’s hackneyed adage, “When a hammer is the only tool in
your toolbox, soon all of your problems begin to look like nails,” it seems as if security is
the only tool in the JCO toolbox and all misbehaviors look like a security threat.
The training philosophy we observed contributes to the adultification of Ohio’s
juvenile corrections system.
Based on the training and job shadowing provided to the new JCO, he or she
likely goes into a situation assuming that the youth want to fight. Youth see a JCO’s
hostile, menacing appearance (stern looks, tough and confident demeanor) and respond in
kind with a hostile display (or bravado for peers). New staff conclude that their original
expectation was correct: The youth do want to fight. It never dawns on anyone that
perhaps staff that look for trouble, create or sustain the hostility.
Whatever its origins, the adult corrections metaphor is a bad choice for use with
juveniles but an even poorer choice when used alone or without a treatment strategy. Not
insisting on a duty to perform rehabilitative functions from the JCO allows, even
encourages, JCOs to entertain a very limited set of solutions to solve any problem and a
very limited set of ways to organize themselves. JCOs solve problems by sanctioning
inappropriate behaviors (tickets, behavioral incident and discipline reports), tightening
controls, introducing more discipline and structure, sending for reinforcements (signals or
codes), or clarifying responsibilities, i.e., holding youth accountable by focusing greater
time and attention on the relationship between misbehaviors and sanctions.
Application of an adult corrections philosophy to juvenile corrections usually
means (a) a diminishing of the roles and responsibilities of line staff (JCOs), i.e., they
would no longer be viewed by youth or the system as adjuncts or partners in the behavior
change or rehabilitation process, and (b) an increasing emphasis on safety, security, and
control in the job description. These safety, security, and control functions are viewed by
administration as much less complex, requiring fewer skills on the part of JCOs and,
therefore, based on extrapolations from the adult corrections experience, capable of being


accomplished with fewer numbers of staff with lower pre-employment qualifications and
pay grades.
The architecture of Ohio’s juvenile corrections has taken on prison-like qualities,
i.e., harder construction, increased and enhanced security technology, and the ability to
lockdown quickly various areas of the institution from a central surveillance location.
The exemplar of this architecture is, for example, the Marion Juvenile Corrections
Staff are trained to find problems and to sanction them, i.e., hold youth
accountable. PbS data suggest this confrontational approach disproportionally affects
outcomes negatively. Staff functioning with this approach appear to far outnumber the
positive ones mentioned earlier, and they have the dominant influence in most of the
general population JCFs.
Many of the staff interviewed expressed a sense of moral outrage about the youth
in their care, of a need to enforce accountability for the derelictions of the youth in their
charge. Certainly nothing in the training was designed to even challenge these beliefs;
beliefs that when translated into action creates a battlefield mentality.
Staff repeatedly raised the same question, “What about the victim?” References
were made to the sexual abuse of children, and then someone would ask the hypothetical
question about how you or anyone would feel if one of these youth had raped your child.
In each interaction, staff cynically juxtaposed heinous behaviors with “official” DYS
consequences of playing video games, watching TV, or having pizza parties. These JCOs
are angry that an adequate or sufficient punishment had not yet been inflicted upon these
youth. They expressed a sense of moral outrage that DYS would allow youth to continue
to get away with disgusting behaviors.
Armed with the righteousness of moral outrage these staff members are quick to
move to a physical restraint or excessive force, and often are strategic in the location to
avoid cameras or to shield cameras from the view of the force. Their behavior, then, is
not viewed as improper; it is the hand of the righteous combating evil.
One ORV resident interview group (six youth) was unanimous in its allegations
that it had witnessed staff assaulting youth. Several youth in the group described different
ways that staff would physically abuse them. They indicated that staff would initiate a


restraint and then call for an administrator. The abuse occurs between the time of the call
and the arrival of the administrator. Youth claim that JCOs tell the administrator that the
youth acted out or attacked them, so they were forced to initiate an immediate restraint.
The youth then claim that the official response from administration is that they arrived on
the unit after the restraint was initiated.
In response to the question about how staff get away with excessive force in areas
with cameras, the group described a process where JCOs would stand between the
offending staff member and the camera while excessive force was applied. They
indicated that an example of this strategy occurred the evening before at about 8:00 p.m.
on their unit.
Following the interview, interviewer David Roush asked to see the digital
recording from that particular unit. It seemed a simple request since on the previous day
he had watched as one management person located and showed the digital recording of
my tour of the same living unit. For this request, a series of technical problems and
omissions prevented anyone at the facility from being able to retrieve the video. Staff did
find the incident report and one administrator indicated that he had direct knowledge of
the restraint. He qualified his comments by stating, “The restraint had already occurred
by the time I reached the unit.”
Expert Roush made several other, equally unsuccessful attempts to see the camera
recording of this event. DYS has not refuted the claims of these youth despite the
existence of a camera system designed for that very purpose.
Staff training overemphasizes the prevention of problems. “No problems,” “no
tickets” become the primary indicators of a youth’s success as opposed to exhibiting
progress, appropriate behavior, and learning. As mental hospitals found “success” in the
silence of their residents brought about by the newly discovered psychotropic
medications; as prisons take pride in no escapes, no suicides, and no “tickets” for
inmates, JCFs follow in their wake.
Training appears to strengthen the JCOs’ ability to spot misbehaviors and to
determine the appropriate amount of sanction, consequence or force required to induce
compliance. A competent youth behavior management training program would teach
staff members (1) how to weaken or eliminate misbehaviors and (2) how to expand and


strengthen appropriate behaviors. The DYS adult corrections bias focuses on only onehalf of the process and thereby contributes to the overall malaise.
As one example of a standardized omission of the positive aspects of youth work,
the “On-The-Job Training Manual” provided us for our assessment contains 52 pages of
performance objectives and steps (activities) that constitute a checklist of training
activities for new JCOs. All of these activities must be demonstrated to the new JCO, and
the designated staff member then ensures that the new JCO performs each activity.
Nowhere in the 52 pages is there anything that addresses the importance of
reinforcement, encouragement, or praise. Nowhere is there a step or activity that teaches
a skill of recognizing what youth do appropriately.
Training staff understand this problem, and most indicated that they or their
trainers do try to talk about the importance of a positive approach. At IRJCF, the trainer
provided a PowerPoint presentation about reinforcement of positive youth behavior.
There were no indications that the materials are part of the training curriculum, or a
lesson plan, nor a record of its use.
Staff training currently lacks clarity on the fundamental distinctions between legal
rights and duties. For every right possessed by youth, there is an affirmative duty placed
on staff. Where law is mentioned or taught it is by non-lawyers and too often as a device
to avoid liability.
Each area of juvenile law on point has its own substance: use of force, isolation,
mental health, and so on. Staff, of course, must know when and how to use force. They
also should know why the law is different for youth; the long history of legal distinctions
based on youth; the law’s implicit and explicit adoption of reduced culpability and
salvagability based on youth; the law’s commitment to reformation.
To that end, we would urge the creation of introductory and advanced courses on
juvenile law and custodial obligations with regard to youth. This writer would be pleased
to prepare such materials, pilot them, and “train the trainers” for the future.
Training Remedies
What follows is a series of suggestions for consideration of the parties in revising
and improving existing DYS training programs:



All training topics should have a lesson plan that exists separate from
PowerPoint slides and contains training objectives, useful participant
handouts, and an evaluation experience that identifies participants who
have not acquired basic skill levels because of the training.


More trainers are needed. There should be a full-time trainer for every 50
FTE staff members.


DYS should upgrade and expand its training materials, particularly
audiovisual resources that are juvenile specific. The Training Department
should consider establishing a relationship with the juvenile justice
training staff at the University of Illinois at Springfield.


DYS should improve the content and quality of staff training by
embracing a balanced approach to juvenile corrections, specifically a
strengthening of the JCOs skill development from a strength-based or
positive perspective. The current training program is out-of-balance and
overemphasizes discipline and control. Safety and security are
strengthened, not compromised, by a strengths-based component.


Changes in the philosophy of JCO training must be reflected in the
recruitment and selection of new staff. It is far easier and more effective to
teach someone who likes youth how to do safety and security than it is to
teach someone who does safety and security well how to like youth.


DYS needs to change its training strategy and materials away from a adult
corrections philosophy to a juvenile corrections or juvenile careworker


DYS should collect feedback and information from each JCF regarding
local training needs for JCO staff.


DYS should conduct focus groups to evaluate and improve OJT.


DYS should infuse a positive and strengths-based perspective into line
staff training materials whenever possible.


Courses in juvenile law and recognizing and dealing with mental illness
should be developed and initially taught by recognized experts in the field who would
then “train the trainers.”


Health Services Overview
The physical health care needs of incarcerated youth rest on the same principles
of cognitive, developmental and associated disabilities as the provision of mental health
care. There is no question that incarcerated youth have a legal right to appropriate
physical as well as mental health care. 42
As Michael D. Cohen, M.D. et al point out:
Although there is a pervasive impression that adolescents are “basically
healthy,” this is not always the case. There are many chronic conditions
that are present from childhood, and many of the chronic diseases of
adults, such as hypertension, Type-2 diabetes, and coronary artery disease,
have their onset in adolescence. Although youth may not yet be
symptomatic or disabled, they still need care to prevent long-term
complications of these conditions. Asthma is the most common chronic
medical conditions, but there are a multitude of childhood chronic
illnesses with a prevalence of 1 per 1,000 or less, which are found in youth
served by juvenile justice programs. Recurrent or persistent symptoms in
an apparently healthy youth may be the initial presentation of a serious
chronic illness.
Several studies have examined the prevalence of chronic conditions in
adolescents and delinquents. An analysis of the 1984 National Health
Interview Survey showed a prevalence of 6.2% for all types of disability.
The four most common disabling conditions were mental disorders;
respiratory conditions, principally asthma; nervous system disorders,


There is no clear line of cases distinguishing the right to correctional health care for juveniles from the
same right for adult inmates. William J. Rold, The Legal Context of Correctional Health Care for Juveniles
in NCCHC, Standards for Health Services in Juvenile Detention and Confinement Facilities 14-5 (2004),
correctly posits the Fourteenth Amendment to the U.S. Constitution as the juvenile’s constitutional basis
for the right, but his discussion of the right itself simply parallels the adult’s Eighth Amendment rights as
initiated by Estelle v. Gamble, 429 U.S. 97 (1976). This would mean a medical need must be “serious” and
the poor medical care must be traced to a provider’s or custodian’s “deliberate indifference.”


principally seizures; and disorders of the ear and mastoid, principally
hearing impairments. 43
The modifier “appropriate” refers to the special medical considerations dictated
by youth. Issues of delayed puberty and short stature, nutritionally adequate diets, health
promotion, and disease avoidance may not be entirely unique to the juvenile population
but they are of transcendent importance.
A medical record either is or is not fit for its intended purpose and has no special
requirements for youth. Continuity of care concerns are crucial for adults and juveniles.
Injuries, in turn, are quite common in juvenile facilities whether caused by
youthful exuberance, staff or youth assaults or athletic activities. In turn, there must be
clear guidelines for clinical assessment and physician referral.
Juveniles in custody have at least the same constitutional right to medical care as
their adult counterparts serving time in prison. 44 This means that only serious medical
conditions mandate care and that care is evaluated by the standard of deliberate
indifference; a standard less demanding on providers and system functionaries than
malpractice. In my view, the fact that juveniles in the custody of DYS have not been
convicted of a crime, that the source of the right is the Fourteenth Amendment’s Due
Process Clause, and that the consequences of medical failures for youth can be more
serious and certainly more long-lasting than for adults argues for a wider net of legal
responsibility. 45
I used a similar approach in discussing a juvenile’s right to correctional mental
health care. That is, one can use the Due Process foundation for juveniles’ rights as a
springboard to broadening the medical conditions requiring care or one can accept the
more narrow Eighth Amendment-Estelle v. Gamble base but argue that “serious” and
“deliberate indifference” have a different, more expansive, meaning in the world of
juvenile corrections.


Michael D. Cohen, Larry Burd, & Mary Beyer, Health Services for Youth in Juvenile Justice Programs
in Clinical Practice in Correctional Medicine 120, 135 (Michael Puisis, ed., 2d ed 2006).
See note 41, supra.
See American Public Health Association, Standards for Health Services in Correctional Institutions,
Standard VII.B (2003).


Juveniles, of course, are not placed in official custody for medical care; the right
to medical care arises from conditions detected when custody is assumed. With mental
health care, one might argue that juveniles are placed in official custody, if not
exclusively, then importantly, for rehabilitation and that mental health treatment is a
significant subset of rehabilitation. Thus, the expansive legal argument for mental health
care may be somewhat easier to sustain than the one made here for medical care.
As this Section unfolds it will become apparent that the DYS system is riddled
with serious deficiencies. For example, the medical assessments performed at Scioto JCF
are not monitored for quality or accuracy and do not “connect” the youth to the receiving
facility. Medication administration does not meet current nursing standards, laboratory
services have been subject to serious delays and inaccuracies, medical records are
incomplete, preventive care is dubious, and chronic care clinics simply do not exist.
The Medical Director clinically manages the Central Medical Unit at Scioto,
spending between 600-800 hours annually on site. This hardly leaves time for peer
review, quality assurance, policy development or any other activities associated with
medical leadership and administration.
As will be developed, this is a system in search of system and in need of
fundamental change in order to provide legally obligated medical care.
Current Structure of Medical Services
DYS has one civil servant physician who serves as the Department’s Medical
Director. This position is considered a Bureau Chief and reports to the Deputy Director
for Treatment and Rehabilitation Services. All other physicians are employed by contract
for a maximum number of hours per fiscal year. Dental services are also provided by
contract and are addressed under Dental Services in Section VII in the main report.
Consultation (technical supervision) for complex cases is provided by the
Department’s Medical Director and direct supervision is provided by the Program Deputy
at each facility. The Medical Director currently conducts no peer review. This should be
a requirement of the position to insure that medical practice standards are being met.
Policies that govern the practice of medicine in DYS facilities should be promulgated
through this office and the Medical Director should have recognized authority in this


There is a Director of Nursing at the Bureau Chief level and all Health Care
Administrators report to this individual as well as to the local Program Deputy. The
collaborative relationship between the Medical Director and the Director of Nursing is
not currently defined and ultimately must be. For example, nurses are responsible for
completing initial health appraisals and physicians should have a role in designing those
appraisals so that critical areas of adolescent development and health history are
adequately addressed along with family history and personal history of medical and
mental health.
The Medical Director and Director of Nursing should drive policy/procedure
development for all medical matters and submit that material for Departmental approval
through the Deputy Director for Treatment and Rehabilitation Services. Each should, as
appropriate, participate with the Program Deputy in the assessment and evaluation of
physicians and healthcare administrators at the facility level based on clinical practice
requirements and current position description specifications.
Medical Assessments
Initial assessments are completed at Scioto Juvenile Correction Facility and the
information contained in these documents sets the parameters for care and treatment of
youth during his/her stay at ODYS. Timeliness of the completion of all initial
assessments (medical, mental health, education etc.) is monitored at Scioto and reported
to institution administration and central office managers.
Timelines currently are being met for the majority of cases. There are no
penalties, except incidentally for the youth, if the work is not completed in a timely
manner. Those penalties include delays in enrollment in the educational program and the
provision of medical and mental health treatment.
The quality and accuracy of these initial appraisals is not being monitored. This
quality improvement process must be added to the Scioto protocols and rigorously
pursued. The history provided by families is not correlated with the initial or subsequent
medical and mental health assessments completed at parent institutions. Also absent
from the initial appraisal are assessments of physical and sexual development based on
age and the youth’s current nutritional status. Hearing and visual tests are to be


completed as parts of the initial physical examination process but often were absent from
the medical file.
As part of the transfer process, physicians’ review the initial and transfer
documents, if available, and document the review in the progress notes section of the
individual youth’s file. These notes give no indications of the physician’s conclusions
based on the information available. No health status is included; for example, healthy
male, immunizations complete, no significant youth or family history of chronic disease
or mental health issues noted. When a medical problem has been identified there is no
physician note indicating the status of the problem or response to treatment, or even a
timeframe for actually examining the youth.
Youth are not present during these initial physician record reviews. When the
youth is seen there is no correlation of information documented to confirm the
physician’s impressions from the record review. The lack of documented information
results in delays in needed, and at times, vital treatment or the recognition of chronic
disease. In some cases, acute conditions also were missed, or treated but not
documented. The only penalty we could detect is suffered by youth who have not
received adequate medical care.
The failure to document the use of available information and connect that to the
youth’s current health status must be immediately corrected. The policies on Health Care
Appraisal and Examination (403.11) and Special Needs Health program (403.15 III and
IV) should be revised as well as the Transfer Health Appraisal (403.12). The failure to
document clinical impressions and integrate information that is available results in the
provision of inadequate or incomplete care that may then require a higher level of care,
e.g. emergency room care or hospitalization at a later date accompanied, of course, by
needless pain and suffering.
Recommended Improvements
1. Initial health care appraisals should be completed by RNs’ and there should be an
area for the physician’s signature and comments. These appraisals must include
an assessment of the adolescent’s physical and sexual development, nutritional
status as well as the areas of mental health etc.


2. The transfer health appraisal must be completed by the sending facility and
accompany all youth at the time of transfer. These must include: a summary of
findings, a summary of care and treatment provided with the youth’s response, a
list of current medications and compliance and a list of specialty appointments
completed or pending.
3. The receiving facility, RN and physician should document a review of the
materials received and correlate that information with the youth’s health status on
arrival and at the time of the initial examination by the physician.
4. Chronic care clinics should be established for youth with chronic diseases.
Monitoring of the youth’s status should be consistent with nationally established
guidelines for adolescent care. These same standards should be used to develop
institutional procedures driven by ODYS policy. There is currently no chronic
care program! Youth with chronic diseases are not seen regularly for status
checks and the assessment of the efficacy of the current treatment regime. This
basic lack of care leads to episodic treatment at higher levels than might have
been required. The lack of chronic care clinics for those who require them
illustrates systemic failure to engage youth in their own effective disease
management and care.
5. Policy and procedure must require an active system of care with youth seen at
the first available physician visit following an acute episode of illness, a specialty
appointment, hospitalization, etc.
There must be better integration of all available medical information. The
diagnostic conclusions and consequent care based upon this information must be clearly
and specifically documented and maintained in the medical record. Failure to correlate
and validate information as received and used by qualified clinicians leaves the youth at
medical risk and DYS at risk for failure to treat, or properly treat, when the information
is, and has been, available but not been used.
Determining that an acute or chronic disease is not present should also be
consistently documented.
Medical information and its use while at the reception center sets the course of
care for youth during his/her entire DYS stay. Qualitative reviews of the material


collected and used should be routinely monitored. Corrective action, including policy
and procedure review, education and training, should be taken in cases where
assessments are incomplete; accurate information is not relayed in a timely manner or
follow up is not documented.
Infirmary Care
DYS has a central medical unit (CMU) at SJCF that is clinically managed by the
DYS Medical Director requiring 600-800 hours of his time on site annually. This unit is
used primarily for convalescent care and appears to have an adequate number of beds
(10). Each facility uses a local hospital for emergency care, local specialists may be used
for chronic and acute disease and/or providers utilized prior to incarceration may
continue to provide care as required.
A review of four infirmary cases, all involving recent surgery, revealed gaps in
the medical records. In one case, the record from the parent institution had not been sent
and was never available during the youth’s stay even though he was not to return to the
same institution. Medical staff were providing care having no idea of the youth’s history
or needs beyond the immediate post-operative state.
Three of the youth had abnormal blood pressure readings that were never reported
to the physician, noted by the physician or assessed over time. A youth with asthma used
his inhaler three times in one week; these were not reported to the physician nor were
peak flow values recorded by the nurse. Team members brought each of these cases to
the attention of the Medical Director.
The amount of time the Medical Director spends on the provision of direct care
must be considered in relation to his administrative responsibilities of peer review, policy
development, and quality improvement initiatives etc. It appears that the amount of time
spent in direct care at the CMU and as consultant/provider at other facilities severely
limits his ability to conduct these activities in a timely, consistent and meaningful
manner. As DYS assesses the ongoing requirements for an acceptable level of medical
care, the overall requirements of the Medical Director position and support staff for this
position must be seriously considered and then clearly defined. Performance consistent
with these requirements should then be monitored as with any other DYS position.


Medication Administration
Medication administration in the majority of DYS facilities did not meet current
nursing practice standards. Medications were prepared in advance and not always
administered by the nurse who prepared them, a serious misstep. Medications also were
recorded before they were administered, not recorded at all or recorded at a time other
than when administered. Blank spaces on the medication administration records
(MAR’s) were not reported as medication errors as required by DYS policy.
DYS recorded a total of 35 medication errors for a 12-month period for all
facilities. Reviews of MAR’s at every facility showed that one facility easily could have
that many errors in one month with omissions (medications not given as ordered) alone.
There is no assessment of the impact of the medication error whether it’s the wrong
medication, medication administered to the wrong person, effects of a double dose due to
recording errors, or not giving the medication because it was not available, and so on.
There are several layers of risk involved: not giving medications as prescribed may
contribute to worsening of the illness and require more complex treatment as a result; and
overdosing can result in an extreme response requiring emergency care or hospitalization.
DYS is also at financial risk for the medications as ordered and the cost of
additional care and treatment.
Medications can be ordered on an as needed basis; to deal with recurring pain is
one example of when this usually occurs. The physician's order usually specifies the
number of hours that must lapse between doses ("one dose every three to four hours")
and may also include the maximum number of doses that can be administered within a
24- hour period (for a maximum of eight doses). DYS currently makes this type of
medication available upon request (as it should be) at breakfast, lunch and dinner-regular
medication times. The purpose of as needed or "PRN" medications is to effectively
control or maintain a manageable level of pain or to diminish the acuity of an asthma
episode. These medications must be available by request and consistent with the assessed
need for them 24 hours per day, as ordered.
One facility has self-administered medications for all youth. Individually labeled
medications, including the youth’s name, the name and dose of the medication and the
frequency of administration identified are provided for each youth. The youth and


supervisory staff member both sign that the medication was administered, refused etc.
This is evidence of a program that provides education on the importance and purpose of
the medications as ordered and engages the youth in the management of his care. All
failures to comply with medications as ordered are immediately addressed by the nurse
and documented. Such interventions are rarely required as reported by staff and youth
and confirmed by record review.
Pharmacy services, especially for those facilities contracting with ODMH, are not
routinely monitored for timeliness and accuracy of deliveries. Delays in providing
medications as ordered results in potential harm to the youth. Delay can also result in
additional cost to DYS when medications must be purchased from the local pharmacy to
cover the gap.
Joint monitoring of the pharmacy contract and its provisions should be conducted
not less than quarterly with facility staff and the pharmacy provider. This process was
being considered as we completed our visits but action had not yet been taken.
Laboratory Services
Nurses complete blood draws and prepare samples for laboratory testing ordered
by the physician at all but one facility. Those facilities that use the ODRC, CMC lab
have experienced delays and inaccuracies in test results. These issues are being
addressed by ODRC and recent improvements were noted. Those facilities that utilize
local or private laboratories have had no difficulties with the timeliness of results or the
accuracy of values as reported.
Phlebotomy services should be considered for the reception center due to the
number of tests routinely required.
Physicians initial and date lab results as they are reviewed. There is, however, no
progress note that addresses variances from the lab norms and the impact, if any, on the
care to be provided. This is both a documentation issue and an integration of care issue,
as other members of the treatment team may not recognize the impact of lab values on the
youth’s current health status.
Infection Control
Infection control is not routinely addressed at the facility level. There is an
educational program on infection control strategies included in pre-service training and a


one-hour program during annual training sessions for all categories and levels of staff.
Youth and staff are encouraged to wash hands frequently and all facilities have
educational posters and reminders posted on this specific topic as part of the universal
precautions program.
There is no Infection Control Coordinator and there is no tracking or monitoring
of infectious diseases. This area should be developed by the DYS Medical Director, or
by someone under his supervision, and be instituted as a recognized institutional
program. Infectious diseases must be tracked and many are required to be reported to the
local health authority, e.g. sexually transmitted diseases.
The occurrence of Methicillin resistant staphylococcus (MRSA) and Methicillin
sensitive staphylococcus infections should be tracked by facility and across the system.
None of this work currently is being completed. The lack of attention to infection control
poses a threat to youth and staff alike. Sexually transmitted diseases can be treated but
may require life long medication and special precautions to avoid transmitting the disease
to sexual partners. MRSA is treatable but can be life threatening and approximately
18,000 die of this infection annually.
Medical Equipment and Space
Medical equipment and clinic space is adequate overall. Space for the storage of
medications at the smaller facilities compromises the presence of hand washing facilities
and infection control practices for the preparation and administration of medications.
The area for storage of medical and dental files at many of the facilities is inadequate and
seems to encourage dismantling the file to “make things work better”; a dilatory practice
that should be prohibited. There are no medical records technicians; nurses are
responsible for maintaining the medical records, which takes time away from clinical
duties. All areas, we are pleased to report, were clean and well maintained.
Medical equipment is consistent with population needs and is maintained in good
repair. Dental equipment with the exception of Cuyahoga Hills also was consistent with
population needs and maintained in good repair. The status and use of medical
equipment should be regularly reviewed so that adequate planning and timelines for
replacement can be established.


None of the facilities have room for infirmary or convalescent care in the medical
area. The use of the ten beds in the central infirmary located at Scioto seems to be
working satisfactorily despite the transportation logistics that must be considered from
both time and cost perspectives. Youth are transported to OSU, Columbus Children’s or
a local hospital for emergency or scheduled care and then to the central medical unit
(CMU) for convalescence, if required. One example of this is youth with a broken jaw
who have corrective surgery and then spend six weeks at the CMU. Frequently youth are
not to return to the sending facility and are transported to a new parent facility upon
discharge. At this time, other than improving the consistency and quality of care in the
central medical unit there are no recommendations for change.
DYS policy requires documentation in multiple places and formats. There are
electronic files which must be completed and then added to the paper file, there are the
required shift logs, nurse sick call logs, doctor sick call logs, et al, and the medical file
itself with S (subjective) O (objective) A (assessment) P (plan) (SOAP) notes. Much of
this information is duplicative and results in gaps or incomplete documentation in each of
the formats required.
The medical record is to be a chronological and complete record or ‘story’ of the
youth and all aspects of care provided. This includes each element of history (medical,
psychiatric, developmental), each complaint, problem or need identified and the
assessment and diagnosis in each instance through the treatment and response or outcome
of care as provided. DYS has improved the order and organization of the medical file but
much remains to be done to make it a complete document that is an effective means of
communication between shifts and disciplines.
Problem lists should be located in the same area in each file and readily apparent
or available in the file. Those lists should be current and list all problems of significance;
issues that have been treated and resolved should be so identified as indicated on the form
in use. Medical records should be reviewed quantitatively and qualitatively to insure that
information is complete and accurate. The youth’s current status with regard to chronic
disease should be clearly identified on the problem list and in the plan of care.


The history reflected by the problem sheet is important to the overall care of each
youth and especially important to the care of those with chronic disease. The medical
history of each youth must be as complete as possible, consistent with identified
problems or needs and available to all members of the treatment team. The medical
history that is established initially by the physicians at SJCF sets the parameters for care
throughout the youth’s stay so complete integration and accuracy of all data available is
required. The current reception process does not insure that this will occur and must be
addressed by the Medical Director and Director of Nursing.
Physician notes were found to be incomplete. They must be comprehensive and
include the course of care, the problem, the treatment, and the outcome of each treatment
provided. Notes should address the history and testing used to reach a diagnosis as well
as a complete description of findings upon physical examination. The degree of control
should be identified for chronic diseases and the level of acuity should be clearly stated
for new diseases.
Examples of inadequacies are as follows: A youth with a history of asthma and
receiving medications was received at the parent facility and while the chronic disease
and medications were noted, there was no statement of health status by the physician.
Medications were not ordered, again without any documentation on why, until six days
Another typical example is that of a youth complaining of urinary symptoms. A
urinalysis and testing for sexually transmitted diseases (STD’s) was completed. One
week following the initial appointment an antibiotic was prescribed for two weeks. The
physician’s note did not indicate that he had seen the youth or the reason for medications.
The urinalysis was normal and the STD testing was negative. The physician did see the
youth several days after the antibiotic was started but for a new problem and made no
mention of the youth’s response to the antibiotics or that testing had been completed and
was within normal limits or negative. The note indicated only that the exam was normal.
Another youth was noted as vomiting blood, an endoscopy was ordered and
treatment followed. Subsequent episodes of hematemesis followed along with trips to the
hospital and orders for additional testing. There was no information available in the


medical file regarding the hospital visits, the results of testing or any effort by the
physician to follow up on these findings.
These examples are representative of what was not found in physician
documentation across the system of medical care. One need not be a clinician to be
disturbed by our findings. In the scheme of things, these omissions move medical care
on line with mental health, use of force/safety, and education in the frontline of remedial
Vital signs that are significantly above or below the normal range for adolescents
should be assessed for a defined period of time with guidelines for the frequency of
reporting results/findings to the physician. The physician’s review of these results should
identify the relationship to an existing or new problem or disease. Consistent with the
information previously noted, there is no documentation in the file to indicate the
assessments either have been completed or considered by the physician in the provision
of care.
All off site evaluations and appointments require a face-to-face appointment with
the physician and youth to present and discuss the results and the plan of care.
Documentation of this meeting should be available in the progress notes as well as the
individual plan of care that has been documented.

This process, if it occurs, is not being

Youth injury assessments must include a description of the activity or event that
led to the nurse’s examination as well as the description of injuries and the action taken.
Symptoms reported by youth should be verbatim and without interpretation.
Assessments that are incomplete or documentation that is incomplete regarding the signs
and symptoms described by the youth may result in inadequate or improper treatment.
There were numerous examples of youth who complained of symptoms consistent with
urinary tract infections. These youth, depending on the nurse’s note or the verbal
information provided over the phone but not documented, were not seen by the physician.
Those youth who continued to complain of symptoms were eventually seen, 2-3 weeks
after the initial complaint, and testing was then completed. In one of these cases,
treatment was initiated only after identification by a team member, despite test results


that clearly identified a urinary tract infection requiring treatment had been available in
the medical file for approximately one month.
Interval histories, contacts with medical services, need to be made available for
physicians at the time of appointments. This is especially important for youth with
chronic diseases. Failure to report or note interval histories resulted in medications being
continued as usual when data indicated a change was required or should have been
considered. The continuing lack of effective communication and documentation
compromises the quality of care being provided.
Quality Improvement
Quality improvement is identified as an initiative encompassed by DYS but there
is no evidence that the techniques are currently in use. Statistical data is collected and
submitted to a variety of central office areas but there is no evidence the information is
used in any fashion. There is no quality assessment and monitoring program for facility
clinical and program services; no needs assessment of the population to insure that
programming exists to meet those existing needs; and there are no outcome measures for
individual levels of treatment or any aspect of medical or mental health care.
Nursing staff at the privately contracted medical services at Marion complete
monthly quality assurance forms as required by the parent company. These requirements
do not appear to have been adapted to an adolescent population rendering their usefulness
questionable. Completing questionnaires on adult standards of care, the care typically
provided by employees of the company, does not address the identified needs of an
adolescent population. Even if the criteria for review were to be made consistent with
adolescent standards of care, the topics change monthly. The change in topic makes it
impossible to determine if the criteria used (the previous month) are pertinent to the
actual provision of care or to determine if any change or trend has been noted based on
information previously collected.
In the case of dental quality assurance, which had been completed for one month
as required, there was no evidence in the dental or medical files to support the findings
that had been submitted. The areas being monitored included the nurse’s assessment of
complaints of dental pain, the treatment initiated and the follow up assessment and care
provided by the dentist.


An active quality improvement program should be established at each facility and
the provision of care should be monitored and assessed on a regular basis. The program
should include peer review at regular intervals and qualitative and quantitative medical
record reviews at a minimum.
Education on Health Issues, Medication, Nutrition, and Personal Hygiene
DYS nursing staff have developed educational modules for pregnancy, chronic
disease, nutrition and personal hygiene classes. Nurses complete these modules with
youth during intersession and, as required, on a one-to-one basis. Youth seem to enjoy
and learn from these sessions. Youth frequently identify topics to be included in the
curriculum. The success of the program is based on verbal reports from youth because
documentation of the key points presented and the youth’s comprehension and ability to
apply the information to his/her care is not consistently available. Many of these topics
could be considered for inclusion the educational program in the Science and Health
classes. The advantage of adding these topics to the education curriculum would make
the information available to a larger population and qualify for educational credit for the
youth participating.
There is an informed consent form and notification process for youth and family
when psychotropic medications are ordered. Mohican has a program developed
specifically for adolescents with pictures and uncomplicated terminology that can be
understood and used by youth. This program reportedly was shared with other Health
Care Administrators but it was not in evidence in any other facility. Notification to
parents/family was months behind at one facility. Notifications at another facility were
completed only with the appointment of a psychology supervisor and immediately prior
to a Cohen team visit.
Youth should be engaged in mental health care and the psychiatrist does
document the risks and benefits of the medications as ordered in her appointment
summary. Family members should also be engaged in this care and have this information
made available in a timely manner. Medical nurses are responsible for the administration
of the medications as ordered and should also be confirming that the consent process has
been completed. This does not routinely occur.


There is no educational requirement or process used for medications ordered for
medical purposes. Nurses’ report providing a basic description of what the drug is
intended to do but there is no documentation to confirm that this has occurred. Classes
on similar medications, the purpose, use, risks and benefits should be considered.
Documentation should include the participants, the information presented and the
individual’s ability to use the information in a meaningful manner.
People who understand a disease process and the impact of the disease, now and
in the future, are more likely to participate in their own care and address medical needs in
a more timely and responsible manner. DYS has a captive audience and the opportunity
to develop a program and relationships with medical providers to enhance the provision
and quality care for youth. They also have, but do not use, these opportunities to develop
positive medical relationships with the limited numbers of youth with chronic disease.
Mental Health Treatment Plans 46
Youth engaged in mental health programs are seen by and involved with
educators, nurse, and physicians. These individuals should have a working knowledge of
the plan of care for these youth and any special needs that have been identified.
Currently, mental health treatment plans are not individualized or completed by a
multidisciplinary treatment team. The psychiatrist addresses future plans and any
education provided in a narrative summary following each individual session. This
information is available in both the medical and mental health file, usually within seven
days following the appointment.
No other mental health information, beyond the initial intake screen, is available
to medical staff. It would be preferable to have one medical record that housed all
information but short of that there must be some form of communication so that nurses
and physicians can respond to behaviors as prescribed in the individualized mental health
treatment plan and in concert with mental health staff members. Medical staff should be
represented on the interdisciplinary treatment team.
The plans that are in use are restrictive and concentrate on extinguishing
behaviors without offering acceptable behaviors or developing new skills to resolve


Despite the potential redundancy with Section IV on mental health, I elected to retain these comments
since they come from a nurse and a physician.


problems effectively. Mental health services require immediate and ongoing attention
and they require integration with medical services.
Special Management Plans
Special management plans are used as a disciplinary tool for youth who
frequently aggressive or flagrantly violate institutional rules. There are three levels of
special management plans with the least restrictive generally used for youth receiving
mental health services.
These plans, like current mental health plans, are based on extinguishing
behaviors without offering acceptable alternatives. There is a team approach to special
management plans usually including the Superintendent, Psychology Supervisor and
Custody staff. Excluded medical staff should be represented at these meetings to
coordinate elements of necessary medical treatment. There does not appear to be any
assessment of facts beyond the immediate charge or violation. There is no review of the
outcome of the plans when used previously or the frequency of use of the same plan for
the same youth for the same problem. All this data would be useful in developing a
meaningful plan. For example, the special management plans in use at Indian River uses
the guidelines that were developed for these plans as the plan itself. The guidelines were
intended as a starting point to the development of a plan that would meet individual youth
needs even when the only consideration is discipline or correction of a recurring problem
Staffing for Physicians and Nurses and Related Areas
Staffing allocations for nurses and physicians, and related support staff, medical
records technicians, phlebotomists and secretarial support are inadequate for the current
number of youth housed in DYS facilities requiring a safe environment, education and
treatment for medical and mental health issues.
The number of positions allocated for nursing staff does not appear to have
included a relief factor for these 24/7 positions that is consistent with DYS benefit/leave
policies. If professional competency were maintained at the highest levels, the current
numbers of staff without consideration for days off, vacation and sick leave, disability
and occupational injury leave would still leave a deficit and create problems for youth
and staff alike.


Mandated overtime is being used less in this staffing area because staff members
now have the opportunity to schedule overtime in advance. Mandated shifts do occur
with regularity to meet institutional minimums although nursing staff at most of the
facilities make every effort to work out leaves in advance and minimize the need for
mandated overtime to occur. These efforts should be recognized but do not eliminate the
need for a relief factor to be included in identifying staffing allocations.
Concerns about actual numbers of staff available must be tempered by the time
now utilized for programs and individual or group services. The educational program,
for example, takes priority over many daytime hours and suggests that clinical staff
should have non-traditional schedules. Staffing dynamics and priorities should be
examined and an overall approach to staffing then developed.
Before the numbers of staff required for clinical service can be realistically
evaluated the roles and responsibilities of these care providers and support personnel
need to be clearly defined. The priority is to provide a safe, healthy environment with
zero tolerance for aggression from youth and staff alike. Within the context of no verbal
or physical aggression, staff members have to learn how to lead and provide behavioral
values in the course of daily tasks. Youth and adults need to understand that behavior has
consequences but that proper consequences do not insure proper behavior. Rules should
be simple, clear and enforceable but not designed to delay or remove access to care.
Enforcing the rules should be completed in a consistent and dispassionate manner-not by
manipulating rewards and punishment. The repetitive nature of explaining and enforcing
(saying what you mean and meaning what you say) rules should be a responsibility not
only of staff members but of youth who can take on leadership roles within their own
peer group to aid in the management of day to day activities. (Lighthouse Youth Center
at Paint Creek is an excellent example of this approach.)
Clinical services should be clearly defined and provided in a timely and
professional manner while incorporating the goals identified for each youth in education,
mental health care, and in concert with medical care. DYS had adequate policies in most
of these areas and encourages or requires facilities to develop local procedures or
protocols for many of these policies and yet the deficits and lack of timeliness continue to
occur (e.g. medication administration, documentation, integration of available


information). As noted above, the rules should be simple and clear. These same rules
should be enforced consistently and dispassionately. The quality of care and services
should be monitored and assessed consistently at the local and central level, as should the
availability and competency of staff.
The difficulty in recruiting competent medical staff for existing positions is a
recurring theme. Given the duration of existing vacancies in facilities consideration
should be given to adjusting pay rates to competitive levels with the private sector and to
considering additions to the benefit package.
The current organizational structure does not encourage thinking, the sharing of
effective ideas or decision-making that benefit youth. Encouraging the growth of
professional staff and providing evidence that creative thought and approaches are valued
should also contribute to successful recruitment and retention of competent and
committed staff.
Staffing recommendations for medical and related staff follows as Attachment 1.
Numbers of existing positions were provided by DYS; recommended numbers are
baseline figures and computed on current duties and expectations but not done by
location. These numbers are also related to current population levels. Hours of work
should be consistent with youth and programmatic need and the availability of family.
Nurse practitioners should be added to the staffing mix to complement the number
of physicians and to provide clinical supervision for nursing staff.
DYS provides a 3300-calorie diet, which is consistent with adolescent needs.
Those with special dietary requirements appear to be accommodated and educated.
Pregnant females are to have meals adjusted to meet the demands of pregnancy in
adolescence. These comments are based on the existence of these guidelines. The
nutrition program was not adequately assessed to determine the efficacy of the program
or individual factors. The girls at Scioto frequently complained that pregnancy diets were
not adequate.
There is a crisis of leadership at the Deputy Director level that is reflected at the
facility level. The lack of direction and programming that is evident at the facility level


seems to be generated from Central Office since communication and collaboration are not
in evidence. The messages to those in the field are incomplete and inconsistent at best.
There does not seem to be an acknowledgement that removing a previously accepted
approach requires both a simple explanation of why and a replacement. The same error
that is being made with youth on special management plans is being made with
employees. The impact of these errors for youth and for staff is not easily measured but
it clearly prohibits the accomplishment of providing a safe environment for youth or staff.
The Medical Team visited Scioto Juvenile Correctional Facility, Marion Juvenile
Correction Institution, Indian River Juvenile Correction Institution and Cuyahoga Hills
Juvenile Correction Facility in August and September of 2007. Ohio River Valley also
had a medical but no dental review and basic nursing services were reviewed at each
facility the Core team visited. Youth interviews were conducted at every facility visited.

Medical care and the documentation of the care provided require close attention.
There must be a program established for the recognition and care of chronic
diseases identified in this adolescent population. There must be greater attention
paid to developmental norms and to the standards of care for an adolescent


There must be additional attention to the special needs of female adolescents in all
aspects of programming and care. Developmental milestones for physical and
emotional development should be identified and used in the provision of care and
education. Dietary and physical activity behaviors should be monitored and
designed to engage youth in healthy lifestyle choices that can transfer to a
community setting.


Acute care is provided consistent with need but is not addressed as part of
ongoing care to diminish the requirement for an emergency response and to
engage the youth in managing his/her own health care effectively.


Access to medical staff is adequate and nurses are available 24/7 on site for all but
Freedom Center. The night nurse at Scioto reports to Freedom Center if needed
during the nighttime hours.



Education on preventing disease is reported as being provided but, if it is, is
inadequately documented. The prevention of disease and normal human
development should be a recognized part of both medical and educational
programs and particularly important in an adolescent population.


Plans of care for medical and mental health needs should be individualized and
available in the medical file for the multidisciplinary treatment team that must be


Quality improvement programs and infection control must be developed.


The dietary and nutritional programs should be assessed to insure compliance
with available standards of care for adolescent populations.


Medical staffing should be adjusted to meet operational demand and to set a
standard for care in the absence of nationally recognized staffing ratios,


An active program of health care that is multidisciplinary in approach and
supported by policy and procedure is a current requirement. Engaging youth in
understanding their own needs and participating in care should be a focus of all



Staffing Recommendations 47
1. There must be a relief factor established and considered for all nursing positions.
2. Credentials must be consistent with the population served; e.g. family practice
3. Competency of all staff should be regularly assessed and consistent with program
expectations as described in position descriptions.
4. Peer review should be completed for each professional employee on a regular

Current 22 hours/week


Current 48.5 hours/week

Medical Records Tech

Current 0

Health Info Tech

Current 0


Recommend: 60 hours/week plus
Recommend: 60 hours/week
(Marion not included)
Recommend: 1 for large facilities;
0.5 for small facilities
Recommend: 1 for large facilities; 0.5
for small facilities to complete
scheduling of appointments, etc.
Recommend: 6-15 hours/week
depending on facility need.

The baseline recommendations considered current duties and expectations but not
location or facility security levels. Hours of work should be consistent with program
needs and the availability of youth as well as family members. The increase in nurses
should include nurse practitioners that would complement the physician numbers and
provide clinical supervision for registered nurses. The projections for physicians include
establishing chronic care clinics and an effective healthcare education program.


We offer these recommendations at least as starting points for any subsequent negotiations that follow
this Report.


Juveniles’ legal right to dental care is of equal significance to the undoubted right
to mental health and medical care. Indeed, NCCHC, Standards, Y-A-01 Access to Care
reads, “Juveniles have access to care to meet their serious medical, dental, and mental
health needs.” NCCHC promotes timely access to a licensed dentist and the compliance
indictors, Y-E-06 are:
1. All aspects of the standard are addressed by written policy and defined
2. Oral screening by the dentist or qualified health care professionals trained
by the dentist is performed within 7 days of admission to the correctional
3. Instruction in oral hygiene and preventive oral education are given within
14 days of admission.
4. An oral examination is performed by a dentist within 60 days of
5. Oral treatment, not limited to extractions, is provided according to a
treatment plan based upon a system of established priorities for care.
6. Radiographs are appropriately used in the development of the treatment
7. Consultation through referral to oral health care specialists is available as
8. Each juvenile has access to the preventive benefits of fluorides in a form
determined by the dentist to be appropriate for the needs of the individual.
9. Where oral care is provided on site, contemporary infection control
procedures are followed.
10. Extractions are performed in a manner consistent with community
standards of care and adhering to the American Dental Association’s
clinical guidelines.
The American Public Health Association, Standards for Health Services in
Correctional Institutions, p. 111 (2003), notes:


Dental caries (soft, decayed area in a tooth) and fractured front teeth are
the most common physical health problems among incarcerated youth.
Moreover, adolescence is the age of greatest incidence of caries in the
permanent molar teeth. Filling existing caries and application of pit and
fissure sealants to intact molars are highly effective interventions to stop
further deterioration and preserve the permanent teeth into adult life.
There is not a great deal of case law in the area of correctional dentistry. What
exists is exemplified by Ramos v. Lamm, 639 F.2d 555, 576 (10th Cir. 1980), “[D]ental
care is one of the most important medical needs of inmates.” See also Hartsfield v.
Colburn, 371 F.3d 454 (8th Cir. 2004), on pre-trial detainee, dental care rights.
I need not repeat here what was previously written about competing constitutional
sources for the right and my belief that juvenile status argues for a more expansive test
for mandated care than a narrow reading of the Estelle, “seriousness” – “deliberate
indifference” test.
Caries are endemic to youth and, interestingly, caries was considered to be a
serious condition by the Second Circuit on the theory that it is a degenerative condition
likely to produce agony, loss of the afflicted tooth, or even infection. Thus, a dental
condition viewed by some as “minor” may legally be characterized as “serious” based on
the likelihood of what it may become.
Seriousness alone, however, may not be enough if the requisite mental state is
lacking. In McCarthy v. Place, 2007 U.S.Dist.LEXIS 41977 (S.D. Ohio, June 8, 2007),
the court found that enduring six months of excruciating pain due to an untreated
toothache was serious. However, the court found that deliberate indifference was lacking
since the dentist had an explanation for his omission and the plaintiff’s proof was
inadequate. Place, of course, is about damages while S.H. is about injunctive relief.
What follows is the substance of the Dental Summary Report prepared by team
expert Donald Sauter, DDS, MPA. Dr. Sauter concludes, “that the overall Ohio DYS
dental program is inadequate.” He specifies the areas of greatest deficits and
recommends changes needed to achieve acceptability.


Methodology and Techniques
In preparation for the site visits, Dr. Sauter reviewed policies related to dental
services, Ohio State Dental Board Law and Rules, November 2006, the Ohio State Dental
Board Infection Control Manual, June 2004, Centers for Disease Control Guidelines for
Infection Control in Dental Health-Care Settings – 2003, and previous site ODYS site
visit reports. He then developed 17 review steps to determine the extent to which the
ODYS institutions were in compliance with their P&P and providing dental care
consistent with the dental literature and regulatory guidelines and rules. These steps
served as standards to provide a focus and consistency for my reviews.
Quality of care and level of care must be distinguished. To determine whether
care is of adequate quality Dr. Sauter looked to professional organizations such as the
American Academy of Pediatric Dentistry, the American Dental Association, infection
control guidelines issued by the Centers for Disease Control and Prevention, as well as
the professional literature. While it may be appropriate to vary the level of care (scope of
services) provided, dependent on a correctional setting, length of time in custody, and the
like, the evidence-based literature describes minimum standards of quality for dental
This report is structured around five areas: 1) access to timely care, 2) adequacy
of physical facilities, 3) quality of the providers, 4) quality of the care, and 5) overall
program management.
Recommendations on how to achieve an “adequate” level and quality of care are
In establishing a definition of an adequate level of care I am cognizant that the
correctional environment is unique and that:
… the focus of correctional dentistry is the control of acute dental pain; patient
education of the major factors that influence oral health and general well-being;
consistent application of preventive dental modalities; the elimination of dental
pathology; and restoration of function … recognizing that … restoring a patient to
optimal function is often a difficult and sometimes unattainable goal. Dental therapy in


the correctional environment should be conservative and meet the professional
standards of acceptable care found in other public health settings. 48
Site Visits
Site visits were conducted at four ODYS facilities. Dr. Sauter accompanied the
Medical Investigation Team comprised of Barbara Peterson, RN, and Ron Shansky, MD.
Two days were spent at each facility reviewing medical and dental records, interviewing
staff, and observing their work. A thorough review of the dental physical plant and its
contents also was conducted.
Access to Care
Inmate Orientation to Dental Care Access
Juveniles should have a clear idea of what dental services are afforded to them.
They should know that emergent care is readily accessible and that routine care may
require waiting to have lower priority dental problems stabilized. Juveniles should have
detailed information regarding entitled care.
We recommend that the ODYS develop a policy regarding inmate access to acute
and routine dental treatment. HSAs and dentists should work together to develop a
system for patient education to include an oral and written presentation describing, in
detail, procedures for accessing each level of dental care provided at their institution.
Access to Oral Hygiene Supplies
An inspection of the personal hygiene kits distributed to the juveniles was
conducted. Dental floss was not present in any of these kits. Dental floss loops were
available for distribution at IRJCF but the system was cumbersome and provides a
disincentive for the juvenile to floss.
It is recommended that floss in some form be made available to the juveniles. It
is necessary to maintain good oral hygiene. Arguments about “safety” are essentially
Urgent Care
The current system of making appointments for patients with complaints of pain
results in some patients not being assessed and stabilized in a timely manner. Dental and


Makrides NS, Costa JN, Hickey DJ, Woods PD, Bajuscak RE. Correctional Dental Services, in Puisis
M. Clinical Practice in Correctional Medicine, 2nd ed. (Mosby, 2006).


medical records were reviewed of patients with chief complaints of pain in DIT -10 49 .
Some nursing entries in the medical progress notes documented adequate stabilization of
pain while others did not. The stabilization of pain by the nurses is inconsistent. The
SOAP format was not used for any of the dentist entries.
The lag between a Nurse Health Call or HSR request for pain and stabilization by
a dentist is excessive. The ODYS is not providing timely (within 24 hours) stabilization
of dental pain.
Juveniles with urgent dental conditions must be able to obtain stabilization of pain
within 24 hours. The nurses should receive training in triaging and stabilizing dental
pain. Nurses should consistently document the assessment of patients requesting dental
care. Furthermore, the dentist and nurses should document emergency or essential /
urgent dental care visits using the SOAP format.
Broken Appointments
Dental patients are typically escorted to and from their appointments by a JCO.
At all facilities visited the dentist gives the officer a list to maintain a continuous flow of
patients. At CHJCF, MaJCF, and IRJCF patients are delivered to the dental clinic in a
manner which minimizes down time. SJCF, however, has problems with patient flow
due to lack of escorts and conflicts in programming.
It is recommended that the ODYS administration eliminate delays in dental
treatment at SJCF and all facilities where patient flow is a problem. Juveniles should be
available for treatment during all the hours the dentists are present in an ODYS facility.
Quality of Care
Screenings and Examinations
SJCF is responsible for the Reception Screening examinations for the ODYS
system. Records were reviewed to determine the quality and consistency of the
Screening Exam (DIT-1). A Dental Screening Examination as defined by the ODYS
Policy 403.13 will: 1) expose dental bite wing x-rays, 2) examine the teeth and tissues 3.)
identify oral health condition 4) specify the priorities of treatment by category. These
screenings must be documented on the Dental Record (ODYS DMH-0059). Therefore, if


DIT-1 through DIT-17 can be found in each site visit report completed by Dr. Sauter. Those reports are
appended at part of Appendix C.


any of the elements of the examination are not present (care prioritized into categories,
oral health condition, diagnostic bite wing x rays, ODYS dental form DMH-0059, etc),
the examination is incomplete and out of compliance with ODYS policy.
The records reviewed at each facility in DIT-1 showed all inmates had Reception
Center Nurse Screening and Assessment and a Dental Screening Examination. However,
most of the Dental Screening exams were incomplete. Priorities of care were not
specified on all of the charts. The need for an annual follow up exam was not
documented in all the records. Timeliness of exams was largely in compliance with
ODYS policy 403.13, except at Cuyahoga Hills Juvenile Correctional Facility.
ODYS policy 403.13 requires the development of an individualized treatment
plan for juveniles receiving dental care. Most charts reviewed did not have a documented
individualized treatment plan. Some charts listed carious lesions, but they were not
prioritized. Thus there was no treatment plan, just a list of problems.
Controls must be put in place to ensure that juveniles be provided examinations as
outlined in ODYS Policy 403.13.
Primary Prevention
In DIT-1, 10 records were reviewed at each facility to measure the level and
quality of dental care provided at intake, and compliance with ODYS policy. While all
the juveniles had documentation of an initial dental prophylaxis and oral hygiene
instruction, none had received topical fluoride treatments. Some topical fluoride is being
applied at follow up dental prophylaxis visits, but the method of delivery (on floss or
painted on the teeth) is ineffective. Fluoride varnish would be an effective way of
placing topical fluoride.
It is recommended that an effective method of topical fluoride application is
utilized as part of primary caries prevention in ODYS.
Dental Sealants
None of the charts reviewed of juveniles who had been at in ODYS for at least 13
months had any documentation of sealant placement. An interview with one dentist
revealed he did not feel sealants were an appropriate treatment as he had seen caries
associated with some sealant placement. Sealant placement and topical fluoride
treatments, however, are recommended as part of primary prevention of dental caries


during the teenage years through early adulthood by the American Academy of Pediatric
It is recommended that the pits and fissures of non-carious permanent teeth be
sealed to help prevent future decay.
Oral Hygiene Education
All of the initial dental prophylaxis and oral hygiene education is provided at
SJCF. One dentist was observed providing intake dental prophylaxis to three juveniles.
No direct oral hygiene education was observed on the three patients being treated. When
the dentist was questioned about what oral hygiene education is typically provided, he
pointed to the posters on the wall. He said he answers questions if the youth have any.
The oral hygiene education program in the ODYS is inadequate.
It is recommended that the ODYS develop a meaningful oral hygiene education
program structured to train juveniles mindful of the disproportionate numbers that have
difficulty learning.
Dental Caries Stabilization - Secondary Prevention
Many of the patient charts reviewed in DIT-1, DIT-2, DIT-9, and DIT-10 had
documentation of dental caries. Not all the dental records reviewed of juveniles who had
been in the ODYS at least 13 months had documentation that caries had been stabilized
or was being watched due to their incipient nature unless the patient refused treatment.
Dental records reviewed showed a systematic deficiency in the area of the monitoring
and stabilization of dental caries. Annual recall exams and dental prophylaxis at CHJCF
were not completed on time or at all in many cases. All other facilities reviewed were
largely in compliance with the ODYS policy on recall exams and dental prophylaxis.
Juveniles at Marion Juvenile Correctional Facility and Scioto Juvenile
Correctional Facility did have documentation of caries stabilization for those individuals
with stays over 13 months. Prioritization and treatment of caries that have progressed
beyond the demineralization stage is recommended as part of secondary prevention of
dental caries during the teenage years through early adulthood by the American Academy
of Pediatric Dentistry.
It is recommended that juveniles with dental caries be monitored by the dentists in

Dental caries should be prioritized by level of severity at the time of the initial


dental exam. Timing of recall appointments for caries stabilization should be based on
the level of the severity of the carious lesions. ODYS should track annual dental
examinations and dental prophylaxis to insure policy compliance.
Removable Partial Dentures, Crowns, and Fixed Partial Dentures
Dental records were reviewed for documentation of replacement of anterior teeth
with fixed and removable partial dentures. The dental literature does show some
correlation between oral health, self esteem, and missing front teeth in juveniles. 50 The
dentists and HSAs were interviewed at each facility about the process of obtaining
authorization for fixed and removable partial dentures and full crowns. Full crowns are
needed to prevent molar teeth treated with root canal therapy from fracture. Crowns and
bridges are needed in a small number of cases to protect and preserve badly broken down
but restorable front teeth. ODYS is providing removable partial dentures, fixed partial
dentures and crowns for patients who need them. The dentist determines the need for a
partial denture or crown and submits the request verbally to the HSA. There were no
reports or documentation of partial denture or crown treatment being denied. There were
no dental casts or dentures available, however, to evaluate quality of prosthodontic
The dentist determines who is to be provided with partial dentures and crowns.
Availability of Specialists
Dental specialists in oral surgery, orthodontics, and endodontics are available and
utilized for patients who cannot be treated by the institution dentist.
Treatment by dental specialists is available when needed.
Special Needs Patients
Dr. Traugh, who works at 3 of the 4 facilities visited, was interviewed concerning
patients with such special needs as mental retardation and mental health problems that
would make them unable to receive dental care without pre-medication. Dr. Traugh has
not had a problem managing patient behavioral problems during treatment. No inability
to treat patients due to behavioral problems was noted in any of the documents reviewed.

See, Patel RR, Tootla R, Inglehart MR, Does oral health affect self perceptions, parental rating and
video-based assessments of children’s smiles?, Community Dent Oral Epidemiology 2007; 35:44-52; Davis
DM, Fiske J, Scott B, Radford DR, The emotional effects of tooth loss: a preliminary quantitative study;
Br. Dent J 2000 188: 503-506; and Margolis FS, The esthetic space maintainer; Compendium Continuing
Dental Education 2001 Nov, 22(11):911-4.


Given the high incidence of mental health problems in juvenile justice facilities,
the issue of special needs management of dental patients should be monitored by the
Quality Management
Quality Assurance
Marion Juvenile Correctional Facility is the only institution visited where there
was documentation of a dental quality assurance program. One quality assurance
“screen” was: “Significant dental conditions are recorded on the problem list”. The QA
report said this in 100% compliance. A review of dental records revealed this was not the
Another QA screen measured was: “All dental sick call requests from the
previous 90 days were triaged within 24 hours”. The QA screen rated compliance as
N/A. This dental program component should have been monitored, as it is one of the
most important functions of the dental program. Many of the nursing assessments of
dental complaints were found to be inadequate. Since nurses are responsible for
stabilization of dental pain in the absence of the dentist. As nurses do the intake dental
screenings they are also responsible for recognizing and triaging dental disease.
Deficiencies in the dental program simply are not being addressed by the current quality
assurance program.
The Marion Juvenile Correctional Facility dental quality assurance program was
rated as ineffective.
Peer Review
There was no documentation of a dental peer review program in ODYS
A clinically-oriented, dental quality assurance and peer review program must be
developed and become part of ODYS policy. This system should have thresholds by
which deficiencies in procedure, quality, or appropriateness can be corrected.
Dental Record Documentation
Health History
A copy of the Nurse Intake Screening form was attached to each dental record
except at CHJCF where the medical and dental records are combined. This screening
form contains a health history which is competed by interviewing the patient and it is


adequate to address conditions that may affect the health of the patient undergoing dental
treatment. The nurse will note dental abnormalities in the dental section of this form.
The health history available to the dentist during treatment is adequate to identify
conditions where precautions should be taken or physician consultations are needed.
Treatment Plans
ODYS dental policy 403.13 requires a treatment plan to be created that
documents dental priorities by category. Review of records in DIT-1 and DIT 2 revealed
dental problems were not prioritized by category. The dental examination is conducted at
SJCF. Dental needs are listed but not prioritized at this exam. The dental charts do not
list the initial components of a comprehensive treatment plan: examination, prophylaxis
and oral hygiene education, and diagnostic radiographs. These initial components are
being completed at the reception center, but should be listed and marked complete on the
treatment plan. The dental carious lesions should be listed in ascending order of severity
so the parent institution can more effectively triage teeth that are a priority for
stabilization to prevent tooth loss.
It is recommended that comprehensive dental treatment plans be created that
prioritize dental problems by level of severity. ODYS should revise their policy to
describing the treatment planning procedure in detail.
SOAP Format
There was a consistent lack of use of the SOAP format in filling out the dental
record for non-routine (urgent care) dental visits. This should be a standard procedure
when the appointment is non-routine, i.e. generated by a complaint by the juvenile. With
juveniles being evaluated and treated by multiple providers, it is important for each
provider to record and assess the patient’s chief complaint to assure it is being addressed
and needed treatment is being provided. The standardized SOAP format creates a
consistent data set, which facilitates tracking of the patient’s progress. The plan should
include follow up to insure the patient is dentally stabile. According to ODYS POLICY
403.05.01 the SOAP format shall be used in the progress note. The SOAP format is a
concise and widely accepted format for documenting urgent dental care. It focuses the
clinician to follow a logical process in diagnosis and treatment.


It is recommended that the ODYS Medical Director ensure policy compliance as
the SOAP format is used most institutional settings.
Physical Resources
Equipment Condition
The dental clinics and their contents were examined at each facility. There is a
general need at all the facilities visited for more instruments used to perform dental
prophylaxis and caries restorative procedures. The dental operatory at IRJCF is in good
condition but the clinic needs some small cabinetry changes to accommodate a dental
assistant. The CHJCF clinic needs complete remodeling of the cabinetry to allow for the
addition of a dental assistant. The MaJCF and SJCF clinics are adequate in space and
A systematic equipment and instrument inventory of all their clinics must be
conducted. Adequate hand instruments and other equipment should be obtained to allow
for uninterrupted dental care while the dentist is present. Necessary cabinetry changes
should be made to allow for addition of a dental assistant.
Human Resources
Dental Clinic Staffing
There are adequate dentist hours allocated to all the facilities visited. However,
lack of a dental assistant makes overall dental staffing inadequate because dentists must
then perform duties not commensurate with their professional competence. Infection
control is compromised without a dental assistant available for surgical retraction, high
speed evacuation, instrument delivery, restraint of sudden errant patient movement, and
proper pre and post dental operatory preparation.
In the interest of a more dentally stabile population, the ODYS could add dental
hygienist hours at the parent (non-reception) facilities. This way the dentists at SJCF
could focus more attention to stabilizing large carious lesions on the male juveniles prior
to their transfer. The initial and annual dental prophylaxis and oral hygiene education
could be done more effectively by a dental hygienist. Dental hygienists could administer
effective topical fluoride therapy.
The oral hygiene education program and lack of topical fluoride application in the
ODYS is clinically inadequate.


It is recommended a dental assistant be hired to work with the dentist when
he/she is at the facility. Consideration should be made to adding dental hygienists at the
parent facilities to improve primary prevention and provide for the stabilization of caries
early in the juveniles stay.
Ohio Department of Youth Services dental policy 403.13 requires a dental exam,
oral hygiene instruction, a dental cleaning and dental ”bite-wing” x-rays for all new
juveniles within 14 days of admission to the ODYS. Due to the lack of dental
hygienists, ODYS dentists are providing the dental cleanings and oral hygiene instruction
at the reception and non-reception facilities. The site visit investigation revealed that the
oral hygiene instruction provided by ODYS was inadequate.
Dental cleanings consume a significant portion of the dentist’s time at Scioto
Juvenile Correctional Facility (SJCF). One side effect is that male juveniles do not have
the access to dental caries stabilization that the current dentist staffing could provide with
the addition of dental hygienists and a change in the deadline for performing the dental
cleanings and oral hygiene instruction.
It is common knowledge in the dental community that dental hygienists are more
competent performing dental cleaning than dentists. They have far more training in
removing hard and soft deposits from teeth without damaging the tissues. Dental
hygienists are also more competent in providing meaningful oral hygiene education to
individuals with varying levels of learning ability. This is especially important given the
incidence of learning disabilities and mental health problems in a juvenile detention
Recommendation: Dental hygienists should be added at all facilities in the ODYS
to improve the quality of the dental cleanings and oral hygiene instruction/education.
Hygienists: Staffing
Many of the juveniles do not have large quantities of hard deposits on their teeth.
This would allow the dental hygienist to perform the cleaning and oral hygiene education
in about 30 minutes. Currently fluoride treatments are not being provided at intake.
Fluoride treatments provided later in their stay are largely ineffective as noted in the
ODYS Dental Summary Report. The dental hygienist could provide effective fluoride


treatments consistent with Academy of Pediatric Dentistry Guidelines. Eight dental
hygienist hours per week per facility would be a good initial staffing level for each
facility. This would be in addition to the current dentist hours.
Recommendation: Eight hours per week of dental hygienist services should be
added at each facility. This should be monitored for effectiveness.
Hygienists: Costs
To support an estimate of costs of dental hygienist hours we quote a recently
published article in the Journal of Public Health Dentistry:
The average dental hygienist in Cincinnati, Ohio, makes $30.00 per hour, with
more than half receiving retirement and health insurance benefits.
Since the dental hygienists will be hired as contractors it is unlikely they will
receive any benefits. The ODYS should expect to pay contract dental hygienists over
$30/hour if they offer only an hourly wage.
Licensure and Required Certificates
According to Ohio Administrative Code, all clinics must have a copy of dentists'
and hygienists’ licensure available for review. No dental hygienist or dental assistant is
employed. Documentation of current licensure of the dentists is on file at all the facilities
Quality of Providers - Dentists
The dentist at CHJCF is not providing adequate follow up for caries, annual
examinations, and annual dental prophylaxis (DIT-2, DIT-3). The dentist at CHJCF is
not removing all debris from instruments prior to sterilization (DIT-15). The dentist at
CHJCF has fabricated removable partial dentures without restoring dental caries. Thus,
the performance of the dentist at CHJCF is believed to be inadequate.
The dentist providing services at IRJCF, SJCF, and MaJCF extracted teeth
without adequate dental radiographs. Documentation shows this to be corrected
following our August 2007 site visits. This dentist is now considered to be adequate. The
documentation of the other dentists reviewed shows their care is adequate.
The quality of three of the four dentists reviewed is adequate. It is recommended
that the ODYS medical director monitor all dental and infection control procedures and
take steps to insure all the ODYS dentists are of adequate quality.


Quality of Providers - Dental Assistants
No dental assistant was employed.
It is strongly recommended that the ODYS provide dental assistants to work with
the dentists.
Infection Control
Some of the barrier techniques being used in the clinic were observed. Spore tests
were conducted weekly in three out of four facilities. IRJCF was sending their tests in
monthly. There was a lack of biohazard labeling on all the ultrasonic cleaners and day
light loaders. The instruments were in sterile packs. CHJCF instruments were
contaminated with dental cement in sterilized packs. This debris prevents complete
sterilization of the instruments. Other handled and stored instruments properly. Eye
protection was not provided to the patient at any of the facilities. The ODYS dental
program will be considered inadequate unless all facilities comply with accepted Center
for Disease Control and Prevention infection control guidelines. 51
Dental extractions are being performed without a dental assistant. This places the
operator and patient of risk from bloodborne pathogens. For example, The Federal
Bureau of Prisons dental policy states, “Surgical procedures will not be performed
without a dental assistant. Institutions should provide one dental assistant for each
clinical dentist.” This is a standard in the private and public sector dentistry.
It is recommended that the HSA and dentist review the CDC Bloodborne
Pathogens Standard and follow the guidelines provided in that document. Current
procedures are inadequate. Dental surgical procedures to include extractions should not
be performed without a dental assistant.
Dental Program Management
ODYS Dental Policy and Procedures
The ODYS dental policy 403.13 was discussed with the ODYS Medical Director,
Dr. John Bradley, and Dr. Mark Traugh the SJCF dental contractor. Dr. Traugh works at
5 of the ODYS facilities and thus has an excellent working knowledge of the overall
ODYS dental program. Dr. Traugh was observed to be a very hard working and

Centers for Disease Control and Prevention. Guidelines for Infection Control in Dental Health-Care
Settings - 2003. MMWR 2003; 52(No. RR-17):[inclusive page numbers].


committed professional. He takes real ownership in the overall ODYS dental program.
Review of the dental records of patient populations managed by Dr. Traugh show his
concerted effort to stabilize dental disease and promote oral health. Dr. Traugh could be
much more effective with the addition of dental hygienist and dental assistant hours at the
facilities he visits.
The current dental policy needs to be rewritten to include instructions on
examination, treatment planning, categories of care, emergent, urgent and routine dental
care, prevention, dental prophylaxis, fluoride treatments, sealants, caries control etc. Dr.
Traugh’s observations and analysis of the problems lead us to believe he is capable of
crafting an expanded and practical ODYS dental policy and procedure manual.
It is recommended that the ODYS medical director work with Dr. Traugh to
expand the dental policy manual. The current manual is not adequate.
As a result of this investigation we conclude that the overall ODYS dental
program is inadequate.
In summary, changes need to be made in the areas of: staffing (dental assistant),
diagnostic radiography (pre-extraction radiographs), infection control (labeling of
biohazards, sterilization of instruments, spore testing, gowns and patient eye protection)
urgent care tracking (complaints of pain assessed, and consistently stabilized and
documented by nursing or dental staff within 24 hours), primary prevention (fluoride
treatments and sealants, annual prophylaxis and adequate oral health education, access to
dental floss), categorizing treatment priorities-secondary prevention (caries stabilizationsecondary prevention, annual follow up exams, fabrication of partial dentures without
caries stabilization), dental record documentation (treatment plans, SOAP format), and
access to care (written and verbal instruction on the specifics of requesting emergency,
urgent and routine dental care).


As the S.H. investigative team conducted its various site visits the Release
Authority was consistently referred to by the various youth we interviewed. Our
experience at Mohican epitomizes the frustration of DYS youth with the Release
Authority. 52
Mohican terms itself a Therapeutic Community (TC); as a one-of-a-kind
correctional facility for males with serious substance problems. The TC program begins
with orientation, moves on to Phase 1 and Phase 2, which are core treatment, and
concludes with Phase 3, relapse prevention.
The entire program takes six months and eligible youth must have at least that
much time remaining on their sentence.
The MJCF intake manager stated that she is very conscious of the time issue.
Because MJCF requires a minimum six-month stay — the average length of stay is seven
months — the intake manager tries to select youths that have six months or more
remaining on their sentences. If they do not have enough time to complete the program,
she will check with court personnel, the Release Authority and the youth’s probation
It appears that by the time youths are being identified as in need of this intensive
substance abuse treatment program, many have less than six months remaining on their
sentences. Consequently, their placement time is being extended by the Release
Authority so that they can complete the program.
For example, one youth interviewed was on ‘revocation’ status; the judge gave
him a 90-day revocation sentence. He was placed in Cuyahoga Hills for 45-60 days with
a release date in July. In June, the Release Authority added five months based on the
“matrix offense” guidelines, considering the time it would take him to complete the
program at MJCF. He was placed in MJCF on June 17.
Four other youths interviewed received five, four, two and one month added time
respectively from the Release Authority — using the ‘matrix offense’ guidelines — in
order to give these youths sufficient time to complete the program.


See Section II, for additional discussion focusing on detention credit.


The youths at this facility, and every other institution, believe that the Release
Authority’s extension of the sentence given by the judge is unfair.
To our knowledge, such extensions are viewed officially as within the
legislatively created upper limit of the judicial disposition — age 21 — and they lack any
pretense of due process. The youth, however, feel powerless and victimized often by
events beyond their control, e.g., an extended stay in reception, which results in a
program time add-on.
The Release Authority does not assess “matrix offense” time while the youth are
at the Scioto Intake and Reception Center. The time is added well after a youth has
entered an institution – not knowing up front how long they can expect to be in an
institution contributes to the youth’s sense of unfairness.
Many of the youths who are ultimately placed in the Mohican program have been
in other institutions for brief periods of time while the selection process is ongoing. For
example, one youth interviewed spent two months in Scioto, one month in Indian River
and when released, he will have spent nearly 8 months in Mohican. Had the referral
process begun as soon as he was committed to DYS, either while he was still in the
county detention center or at least while he was going through assessment at Scioto, he
would have begun his substance abuse treatment virtually upon commitment to DYS and
his bed could have been freed up three months earlier.
The Release Authority Board, effective on July 1, 1998, makes release and
discharge decisions for the Department of Youth Services. The same legislation also
created an Office of Victim Services, the judicial release process, and the requirement for
courts to submit a Disposition Investigation Report (DIR) for each youth committed to
The Release Authority consists of five board members, one of whom is
designated as Chair, three hearing officers, the Office of Victim Services, and support
services staff. The Authority serves as the final and sole agency for release and discharge
decisions based on the standards of public safety and the best interests of the child. 53


Team member David Roush was our principal investigator in this area and he interviewed the following:
Sharon Haines, Jennifer Fears, Norman Hills, Terry Kennedy Mancini, C. Q. Morrison, Renee Burch,
Doneta Riegsecker, Aldine Gaspers, Kristine Bell, Walt Fluellen, and Damita Peery.


Release Authority Functions
The basic functions of the Release Authority include:
1. Setting the Presumptive Release Date (PRD) from institutional care and
Presumptive Discharge Date (PDD) from DYS custody,
2. Completing release and discharge reviews,
3. Establishing expectations,
4. Considering input from victims, the courts, and prosecutors,
5. Meeting with youth, and,
6. Providing system quality assurance.
The first two functions are more objective with specified criteria for calculating
dates and timelines for accepting or rejecting release and discharge decisions. The
criteria appear to be consistent with the Ohio Juvenile Code.
Functions 3 through 6 are less structured and more open to the individual
interpretation of board members. Allegations of inconsistency from JCF residents and
staff stem from the absence of clear-cut criteria along with the method of distributing
caseloads. Each incoming youth to DYS is assigned a board member who is ultimately
responsible for his or her case throughout the DYS commitment. Board members did not
describe much interaction in the review of difficult cases. Indeed, a frequent criticism of
the Release Authority is that the five members appear to function more as individuals
than a unified decision-making body.
Setting Dates
The nature of the Ohio Code and the decision-making criteria of the Release
Authority predispose youth to longer stays than necessary in institutions or on parole.
The courts complete a Disposition Investigation Report (DIR) that includes the arrest
record, victim information, and victim impact statements. The DYS reception process
includes assessments for mental health, medical, education, substance abuse,
leisure/recreation, religious, security threat groups, Prison Rape Elimination Act, and sex

Fred Cohen interviewed Sharon Haines also and held discussions with Director Stickrath and several


The information combines to present a picture of the youth based largely on
problems and deficits. This information combines with the Level of Service Inventory
(LSI) and with the local juvenile court commitment order specifying the offense to
establish the Presumptive Release Date based on the Release Matrix (see Table 1). DYS
staff and residents refer to the Release Matrix as “matrix time,” giving it a supernatural
flavor that it actually may deserve.
Level of Service Inventory (LSI)
There are problems with the use of the LSI. DYS is in the process of addressing
these issues through research by the University of Cincinnati. Director Strickrath
indicated that he expects the findings from the University of Cincinnati study soon.
Nonetheless, the Release Authority was unable to respond to several of the criticisms of
the LSI identified by Austin (2006). 54 For example, DYS has not separately normed the
LSI for girls. This raises the possibility that DYS misclassifies females based on the LSI
since males and females respond differently to the test.
DYS has not done an inter-rater reliability study among those individuals who
administer the LSI at reception. Inter-rater reliability is a significant problem with the
Finally, DYS does not account for the differences between the static and the
dynamic factors within the LSI. This may be addressed in the validity studies undertaken
at the University of Cincinnati. 55
Set and Forget
Director Strickrath expects the University of Cincinnati study (a) to provide DYS
with a greater ability to identify the low risk youth and (b) to provide evidence to change
the criteria for setting the PRD for low risk youth and moving them quickly toward
release. The group will be called “Set and Forget” based on the relative lack of problems
these youth have presented in the JCFs.


James Austin, “How much risk can we take? The misuse of risk assessment in corrections.” Federal
Probation, 70 (2), 2006. Austin argues that inmates are not properly assessed for risk by most agencies.
Austin worries that too much emphasis on risk has diminished efforts to provide basic treatment
As of the cut-off date for preparing this Report, we have not had the opportunity to study the Univ. of
Cincinnati’s work on point.


Release and Finances
The local courts, by statute, also play a role in the release process. The court has
jurisdiction to authorize an early release up to the Minimum Sentence Expiration Date
(MSED). If a court orders release before the mid-point between the commitment (minus
local detention time) and the MSED, the court must provide probation services following
the youth’s release. If the court orders release after the mid-point but before the MSED,
the youth is placed on DYS parole. After the MSED — and most PRDs are beyond the
MSED — the Release Authority has sole jurisdiction. This arrangement calls attention to
the Presumptive Release Date, which is based on statutory requirements that tend to
lengthen a youth’s time in the institution beyond the MSED.
If the court releases before the mid-point, the court supervises and pays for the
services. If the court releases after the mid-point date, DYS pays for and supervises
parole. Like many of the decisions surrounding DYS commitments, the financial
arrangements are critical to understanding decisions. Much of this stems from the
complicated formula for state reimbursements of county expenditures for out-of-home
placements through RECLAIM Ohio.
If our description of the relationship between the courts and DYS ended here, I
think it would be fair to term it bewildering and needlessly influenced by considerations
of finance. As this narrative proceeds we will move beyond bewildering and into the
Review Hearings
Release Authority officials referred to 90-day cycles for reviews. The Authority
notifies all interested parties 45-days in advance of a review hearing. Hearing Officers
conduct informal follow-up contacts with institutional social workers to make sure that
the appropriate paperwork is filed with the Release Authority. While reluctant to indicate
the percentage of hearings that are postponed because of local institutional staff
members’ failures to complete and submit paperwork in a timely fashion, Authority staff
acknowledged the problem and conceded that it occurs more often than is acceptable to
them. We suspect this is “code” for “a lot.”
When asked to explain the reason for this problem, most indicated that JCF social
workers have too many youth on their caseloads and have other duties that distract them


from completing the paperwork. This is yet another example where the number of
positions assigned to fulfill various functions within the institution is insufficient to
achieve institutional goals.
Release Authority personnel conveyed the impression to Dave Roush and Fred
Cohen that they are an embattled group. Several board members emphasized their
advocacy for youth, which they believe goes largely unnoticed because of all the
constraints placed upon their decision-making by Ohio law.
When challenged on issues about length of treatment, about incentives or good
time, or about reducing a youth’s exposure to a dangerous institutional setting, the
Authority officials acknowledged the concerns but blamed their patterns of decisionmaking on systems issues that constrain their discretion. While this is likely the case in
many instances, these protests should not disguise the institutionalized commitment to
public safety. This takes the form of continued incarceration even when it is known (or
believed) that the DYS intervention itself may aggravate the youth’s perceived risk to
public safety. Youth advocacy aside, the Release Authority board members seem clear in
their commitment to make a quality decision about who is ready for release, and “public
safety” trumps “the best interest of the child” every time.
This is yet another decisional point where childcare rhetoric is trumped by the
adultification-law enforcement model. Efforts to treat and rehabilitate are blunted at the
back end of the system.
The quality of release decisions depends on the quantity and quality of
information coming in from the institutions, and hearing officers repeatedly complained
that this is their greatest concern. In the absence of useful information, hearing officers
must increase the amount of time taken to review a file because they have to follow-up
with youth and staff or locate information from various files.
Prior to PRD
Superintendents and Regional Administrators may submit a request for a special
review for an early release of a youth if his or her circumstances change. When asked if
anyone was aware of a superintendent submitting a special request, board member Hills
indicated he had received two from newly minted Superintendent Oprisch at the Indian


River Juvenile Corrections Facility (Oprisch has been with DYS for about six months).
He approved only one.
This is a telling example about the Release Authority. First, no one presented the
special review strategy as being advocated by DYS. Second, even though the numbers
were small, it seems particularly problematic that the Release Authority would deny any
special review request from an institutional superintendent or regional administrator,
except on the basis of technicalities or statutory constraints. In an era of site-based
management, the centralization of the release function increases the disconnect between
institution and release decisions. Denial of a special review and an early release likely
undermines the authority of the superintendent in the eyes of JCF residents. Hopefully,
the denial was based on a technicality or statutory constraint.
Perceived Needs
When asked what was needed to make things run more efficiently, Release
Authority staffers suggested (a) improved internal communications, (b) program
development based on effective outcomes as opposed to whatever was the popular
strategy of the day, (c) a better fit between placements for youth and safe environments to
remedy the inability to separate vulnerable from predatory youth, (d) a shift in facility
operations that returns the juvenile correctional officer to the primary correctional
intervention (a caregiver model), (e) a return to single occupancy rooms, and (f)
programs and services that meet the needs of girls.
The Release Authority board members agreed that it is time for a complete
revision of the Juvenile Code. The current code dates from 1984, and many Release
Authority staff find it as problematic as we do.
Revocations are done by the local juvenile court. There are two general pathways
to revocation, one through the Bureau of Parole and the other through juvenile court
initiative usually based on commitment of a new felony offense or community outcry.
The Release Authority does not play a role in either process.


It is important to understand the financial arrangements associated with the
different types of revocation. First, when a juvenile court revokes the probation or parole
of a youth that it released from a DYS institution before the mid-point date, the juvenile
court usually pays the entire amount of the youth’s re-incarceration at a JCF. Second, if
the court revokes a youth released by DYS, the court typically pays only the first 30 days
of the revocation.
Data on revocations appear similar to the demographics of DYS commitments. It
is difficult to determine any increased level of disproportionate minority involvement in
revocations beyond that already present in the commitment process.
Bureau of Parole Revocations
DYS Parole supervises the youth’s reintegration to the community. In addition to
the conditions for parole, the Bureau supplies a range of program and services to assist
the youth in adjusting to the community. When youth do not comply with the terms of
parole, technical violations occur. The Bureau has a range of administrative sanctions
that include verbal house arrest, electronic monitoring, altering parole conditions or
extending discharge, last chance agreements (sometimes these occur in the home and
serve as official notice to parents), petitioning a youth back to court for an official
tongue-lashing. These strategies help the parole officer keep the youth in the community.
When this approach fails, the Bureau can petition the juvenile court for a hearing
with an attorney to revoke the DYS parole, based on an accumulation of documented
violations. When this occurs, the court typically pays the first 30 days of costs incurred
by the revocation. The Bureau of Parole estimates roughly one third or more of the
revocations occur in this manner.
Re-Offense Revocations
The Bureau estimates that about two-thirds of revocations occur as the result of a
substantial problem in the community, such as committing a new felony offense or in
some fashion eliciting “public outcry” about public safety. We understand that this basis
for revocation is legally dubious, certainly without further explanation, which we are
currently unable to provide at this time. One generalization by the Bureau is that this
second strategy normally occurs in larger counties because of the lack of re-entry
programs, services, and resources.


The primary problem facing the Bureau of Parole is the unpredictability of release
dates. The second major problem is the inability of the JCFs to prepare youth for reentry. Youth do not appear to have sufficient employment skills, employment strategies,
or appropriate places to live following release from the JCF. The magnitude of this
statement of a problem is belied by its brevity. Readiness for release and an affirmative
release environment are critical elements in that continuity of care process.
Summary and Recommendations
The DYS release, discharge, and revocation processes are complicated, involving
many factors that impact the discretion of the individuals charged with making decisions
in these areas. Even the success of RECLAIM Ohio adds a level of complication to the
release, discharge, and revocation equations based on how reimbursement is calculated
and when it occurs in the sequence of events. It will take more than the limited time we
have had to understand more fully the DYS system of release, discharge, and revocation.
However, our time was sufficient to acquire enough information to form impressions, to
discover patterns, and to identify recommendations for improvement consistent with the
objectives of this investigation.
The Release Authority staff is an interesting combination of individuals with
various specialties and experiences. Two hearing officers were former JCF
superintendents, as was the chief of the Bureau of Parole. Among this mix of DYS
staffers, it is difficult to find anyone who consistently endorses the JCF interventions as
effective. Instead, staffers readily admit to safety problems stemming from a lack of
program and treatment consistency and from too many youth with too few staff who too
often opt for security over reformation.
Several changes warrant consideration:
1. The sense of a system out-of-balance starts with the Ohio Code. Any
settlement should include a commitment to further study and revision of
the relevant statutory provisions.
2. Statutory constraints on release and discharge decisions are weighted
against the youth and add to a youth’s time. These constraints need re-


thinking from a procedural, operational, and decision-making basis. That
is, the youth should not be penalized with additional time when staff or the
system cause reception, transfer and paperwork delays and review
3. The special review should become a clearly defined and articulated
procedure advocated by the Release Authority and Central Office as a
means to strengthen (a) site-based management, (b) the creation of
incentives for appropriate youth behaviors, and (c) the reduction of the
average length of stay (ALOS), thus assisting if only slightly in lessening
4. There is a troubling overemphasis on the JCFs as the location for services and
treatments specified by the Release Authority when setting the individual’s
release expectations. When staff generally criticize JCF treatment services as
ineffective and then postpone release until the completion of such a program, the
process appears singularly punitive. There should be an expansion of step-down
mechanisms whereby youth can receive certain specified treatment programs in
the community.


Table 1. The Release Matrix

Low Risk
Felony 5
Felony 4
Felony 3

Felony 2
Felony 1
Category 2


Category 1

Moderate Risk High Risk

2-6 Months
4-6 Months
Core = 4
Core = 5
2- 6 Months
4-6 Months
Core = 4
Core = 5
4-6 Months
5-7 Months
Core = 5
Core = 6
8-12 Months
10-14 Months
Core = 10
Core = 12
9-13 Months
11-16 Months
Core = 11
Core = 13
10-15 Months 12-16 Months
Core = 13
Core = 14
Includes Youth 12-15 years of
Aggravated Murder or Attempted
to Seven Years, or until Age 21.

Very High Risk

5-7 Months
6-8 Months
Core = 6
Core = 7
5-9 Months
6-10 Months
Core = 7
Core = 8
6-10 Months
7-11 Months
Core = 8
Core = 9
12-18 Months
14-22 Months
Core = 15
Core = 18
12-20 Months
14-30 Months
Core = 16
Core = 22
12-24 Months
14-34 Months
Core = 18
Core = 24
age who have committed attempted
Murder. Will serve a minimum of Six



At a meeting in his office, I asked Mr. Rufus Thomas, then DYS Chief Inspector,
if he thought the DYS grievance process was working. His candid response was, “The
quality of the response is the weakest part.”
A recent internal review of the youth grievance process, culminated in a Report
from Andrew Propel, Office of Project Management (OPM), dated September 6, 2007.
The Report noted the importance of the process without explicitly stating what it should
accomplish. Further, youth were found to have easy access to the process based on a
monthly average of 647 grievances filed.
Youth also were found to have a “fair” understanding of the process and while
timeliness in response has improved, required timelines are not being met.
The internal Report noted that most DYS responses are “fair” with a “significant
percentage” granted. I found no definition or criteria for “fair” or specific numbers
supportive of “significant” favorable results for youth.
Access to the process measured primarily by the number of grievances filed is
misleading. Indeed, during our site visit investigations we found that numerous
grievances could be indicative of JCO’s, or even Unit Managers, telling a youth to file a
grievance instead of resolving an individual, early fixed problem.
“These shoes don’t fit and my feet hurt bad!” “So? Go file a grievance.”
One cannot begin to evaluate a grievance system without some agreement on the
mission, the essential objectives of the process. I strongly suspect that there is no shared
understanding, or clearly articulated statement, of such mission.
This is not unique to DYS and it is a problem endemic to adult and juvenile
corrections. One might ask, for example, if the grievance system is viewed as an
alternative to litigation? As essentially an informal local mechanism to quickly resolve
individual concerns? As essentially concerned with identifying and broadly resolving
more systemic issues and, thus, closely related to the Q.A. process? As primarily a
“venting” mechanism more important for the filing of a complaint than its resolution.


I’m certain these are other possible objective but the one’s just listed are quite
representative. What also seems rather certain is that DYS itself has not arrived at a clear
decision and what the grievance process should accomplish.
Without pretending to have done a broad, representative sampling, the youth we
spoke to about grievances had little or no confidence in the process. Questions about its
efficacy were more often greeted with amusement than support.
The recent CIIC Report 56 notes that any youth wishing to file a grievance may
receive the assistance of any staff person. An attorney may help the youth prepare a
grievance form but may not write on the form, may not request its processing, and may
not process the form.
Violation of such rules may result in the suspension of the offending attorney’s
visiting rights. While I understand the desire to avoid creating an adversary process, it is
difficult to understand the hostility directed to lawyers who might help an illiterate youth
prepare a grievance. This type of help is a far cry from a spirited defense or prosecution.
There appears to be a functional breakdown in the grievance process at the
threshold: large numbers of these youth are operating at an extremely low level of
literacy. Without help in preparing a grievance, the youths’ cause for concern and desire
for relief may simply be unintelligible or not presented in a fashion favorable to the
youth. And yet there is no mandated assistance and serious threats of sanction directed at
Curiously, the internal “Popel Report” of September 6, 2007 complains about
grammatical and spelling errors by staff and the use of “shortcuts” (“ua” instead of Unit
Manager). I found no reference there to the difficulty youth likely have in framing a
grievance and asking for relief.
At a minimum, if the grievance system is to work, the youth should have a right to
assistance on the preparation of a grievance. For youth who are unable to orally pursue
their grievance there also should be help available. A simple expedient would be to
create a list of employees from which a youth may select an “adjuvant” for help in
preparing a grievance.


Correctional Institution Inspection Committee Report (CIIC): Evaluation of the Department of Youth
Services Grievance Procedures, p. 80 (Aug. 16, 2006)(Hereafter CIIC Report).


With criteria to be developed to establish need, that same staff list could be used
for the additional aid needed by those youth who lack the capacity or communicative sills
to orally present and perhaps speak persuasively on behalf of the grievance.
This same assistance, in turn, could apply to the appeal process.
No staff member should be allowed to participate in such an assistance program
without having taken specialized training on just how to provide this assistance.
In my discussion with Mr. Thomas I suggested that grievants obviously seek a
remedy consonant with their grievance. However, there are some studies, at least in the
adult system, suggesting that “winning” is not the only measure of satisfaction; a belief
that one was treated fairly may be equally important.
In the same vein, there are three areas of decision-making that most directly
impact youth in the custody of DYS and where there is a feeling of helplessness as to the
decision-making: grievances, discipline and classification/placement/release decisions.
The perceived unfairness of these areas contribute to the youths’ cynicism and very likely
may serve as a needless obstacle to achieving positive change.
In the current DYS system, the role of the institutional coordinator needs to be
revisited and very likely revised. See Policy No. 304.03, Section D for functions of the
grievance coordinator. If an informal resolution is not obtained then the grievance
coordinator appears to be the central figure in any resolution. Yet, the coordinator has no
special training and no clearly defined role. The coordinator may be a Deputy in one
facility and an executive secretary in another.
I was told that “people who are good with data get dumped on” to do this job.
This relates to the Activity Management System (AMS) now in place to document
incidents and grievances within DYS. The grievance coordinator (or Site Manager’s
designee) is to document in the AMS and this may be a case where documentation
requirements overwhelm substantive and procedure needs.
When I asked Mr. Thomas how he would describe the role of the coordinator he
said it was to serve as a conduit and not a problem solver. Who then regularly solves
grievances nee problems remains unclear to this writer. What is clear, however, is that if
the DYS grievance system is to function efficiently and fairly the process must be easily


accessible, youth should have a right to assistance, and the norm should be to resolve
issues at the local level as expeditiously and fairly as possible.
An adversary model is not needed and, indeed, may be a negative element. That
is, there need not be a zero-sum-winner and loser game here. The objective should be to
achieve some measure of satisfaction and a sense of fairness with the youth.
Data collection and analysis should, inter alia, be aimed at detecting grievance
trends suggestive of systemic concerns requiring system-wide action.
The CIIC Report at page 18 recorded a number of problem areas: Only 60% of
the grievances were recorded as completed; 60% of grievances at Indian River and 85%
at Mohican had no response recorded; Mohican granted no grievances, Indian River
granted 5%, and Circleville granted only 4%. Cuyahoga Hills, on the other hand, granted
It is difficult to interpret these wildly disparate results. It would be a mistake to
conclude, for example, that Circleville is an oppressive and unfair facility while
Cuyahoga Hills is wonderfully youth-oriented. Our site visits belay that impression.
More likely, these results speak to what is grieved and how the process is
conducted and not the climate of the facility.
Over a four-month period only 69 grievances were reported on the use of force;
that is, about 3.82%. Our interview and record data studies suggests that staff use of
force is among the most common problem experienced and yet of 464 grievances about
staff in the period studied only 69 were designated as use of force. 57
The “no response” problem obviously is a serious one. The CIIC Report notes:

The lack of response to juvenile grievances is a major problem currently
faced by the DYS system. Several institutions (Cuyahoga Hills JCF,
Circleville JCF, Ohio River Valley JCF) appear to be very good at
recording at least some action taken by the Grievance Coordinator in


Complaints about staff amounted to 25.7% of all grievances for the period, twice as many as the next
category. CIICR Report, p. 23.


response to the grievance. Other institutions, particularly Indian River JCF
and Mohican JCF, report many extremely serious grievances with no
recorded response or action taken by the Grievance Coordinator. This
causes great concern, as all grievances should be answered, most
especially those that are serious.
The following is just a sample of the grievances from January 2006 that
recorded no response or action taken by the Grievance Coordinator. A full
listing of all grievances from January 2006 that did not record any
response/action can be found at the end of this report. (Note: Grievances
have been edited for grammar, spelling, and confidentiality. All notes
made within the text are of the Grievance Coordinator.)
One serious area to highlight is the high number of medical grievances
with no recorded response at Marion JCF. The Grievance Coordinator
even notes that he or she cannot understand what the youth is writing, but
there is no recorded action or response. Face to face interviews should be
imperative in such instances.
Indian River JCF

The teacher … keeps provoking me to get into trouble. This woman
has issues in her household and she bringing it here with her personal
problems. She also tried to kick me…


Medical staff continues to put me on rec restriction and give me
Motrin for an ankle injury which needs to be x-rayed because it is not
healing right.


My roommate passed out and I paged up to ... He came down the hall
and just told me to let him sleep.


Youth … keeps punching me every day in SMP Rec.


Ms. … found out I wrote grievance forms on her and she said every
day she works, she gonna write me up. Need Unit change.


Ms. … switched my room and then after lunch switched me back for
no reason. I don't want to be in Room 17 because my roommate plays
too much.



JCO … wrote me up for drawing a nude female. He put on my YBIR
that I wanted to suck his dick and that I said he was cute.
Marion JCF


My medical needs are not being met. I have a very serious problem
with my XXX (? Cannot read). It dislocates a lot – Medical will do
nothing but give me Motrin (which doesn't work)


JCO … or JCO … let somebody in my room and they took all of my
hygiene I ordered off commissary.


On 1/14/06 I was taken to the hospital for chest pains – The doctors
there told me to discontinue ?? (can't read) a medical DR. she
prescribed for me. I stopped the XXX (?) and Dr…


Youth says that he asked JCO … to call Medical because he hit his
head when he fell off his bed-- He said wait, she'll be over around
11:30 pm – He had fallen at 10:10 1/14/06. He w…


Youth states that he has a serious problem with his left shoulder –
Occasionally dislocates from its socket – I have informed medical
dept. of his problems a lot of nothing gets do…


The JCO called medical to see if I could get my inhaler and she said
wait until medline.


On 2 occasions I was given Motrin for pain relief. In my medical
records it shows that I am allergic to Ibuprophen, which is in Motrin.
The nurse neglected to inform me that there wa…

Mohican JCF

The units have rats in the ceiling.


Youth was accused of assaulting another youth and the other youth hit
him first and did not get discipline for it. JCO … wrote him up.


JCO … threatened to strike this youth because they each disrespected
the other.


Another youth came into his class and assaulted him and he doesn't
feel safe.


Ms. … is racially prejudiced toward black youth and doesn't teach.


Youth's pillow case had racist writing on it.


JCO … gives LE's without Pull Ups and shares sexual information
about women, verbally abuses, threatens and cusses.


JCO … won't sign off on LE's, uses sexual words to him, and threatens
him and cusses him out.


Staff are bringing in contraband to run the units.


Black youth go around in rec. calling white youth "Honky" but the
white youth would get into trouble calling a black youth "Nigger."
They are both racial slurs and should be pe…

Scioto JCF

I signed up for Health Call and they didn't call me for Health Call.
This is the 9th or 10th time they have done this.


I recently got my Level 2 dropped for receiving 7 YBIRs in a week. I
don't think that is fair considering we have Level 3's on Allman who
are openly involved in gay relationships.


Been wearing dirty clothes for a week.


We have had to wear the same clothes for the past week.


I don't receive my meds. Mr. … asked Nurse … if going without one
dose of my seizure medication (would do anything to me). One dose
skipped gives me a migraine and an ups…

Clinical Grievances
DYS should consider using a different process for grievances involving clinical
issues: medical, mental health, and dental. There is simply no way that a person without
training and education in the clinical area of complaint can satisfactorily resolve a
grievance concerning diagnosis, treatment, or prognosis.
Failure to obtain a pass, delayed receipt of medically required shoes, even delay n
receiving, for example, Motrin can be resolved without clinical input. However, where
the complaint involves receipt of the wrong medication, a challenged diagnosis, or the
wrong medical procedure, DYS should consider a process whereby an independent
clinician in the appropriate field reviews the grievance, interviews the challenged
clinician, studies the records, and resolves the problem with ameliorative action.


There would, of course, have to be further study of this proposal and rule making
on point. However, if one objective here is to reduce pain and suffering and limit liability
exposure, then something resembling this process should be considered.
J.P. Litigation
I am, of course, aware of the litigation and Stipulation of Settlement in J.P. v.
Taft. J.P. is independent of S.H. but the right of access to the courts, which includes a
right to legal assistance, is focused on resolving what appears to be the identical issues of
conditions of confinement as encompassed by S.H.
As I understand J.P., the Settlement does not provide counsel for youth to litigate
against DYS. Sharon Hicks, the J.P. attorney, serves as a conduit to other attorneys. In
speaking with her she noted the difficulty in creating a “stable of lawyers” and even in
persuading individual lawyers to accept DYS youth cases for litigation.
Ms. Hicks also regularly visits DYS facilities and reportedly finds herself
advising youth on grievances, answering questions on sex offender registration, and
gang-related issues. In other words, while she is supposed to serve as a conduit to other
counsel and to sort out meritorious from non-meritorious cases, she now seems to be less
conduit and more problem-solver and information provider.
The parties might well consider seeking to consolidate J.P. with S.H. particularly
if there is to be post-settlement monitoring. Youth who seek damages for harm inflicted
on them obviously would retain the right to individual lawsuits and provision could be
made in S.H. for a referral process.
Youth Advocate
Don Reyna serves as the Youth Advocate (his professional card adds the title
“Ombudsman”). This position has existed for about three years and Mr. Reyna has been
in the position since its inception.
In an interview with this writer on October 16, 2007, Mr. Reyna stated that while
he was hired by Geno Natalucci-Persichetti, the job description never was clarified for
him. Indeed, he believes the former Director hired him in response to some [unnamed]
lawsuit but after being hired he was given practically no direction. The current job
description reads:


60% — Under administrative direction, relives the Deputy Director 5
(DD) of the most difficult administrative duties plans, coordinates,
formulates, and implements the Department of Youth Services’ (DYS)
Youth Advocate Program & applicable policies and procedures (e.g.,
ensures complete access by all youth housed by DYS to all applicable
grievance forms, personally assists youth with the completion and tracking
of paperwork necessary to file grievances; etc.): ensures all facility staff
maintain the Grievance Tracking System in order to maintain accurate and
complete record of youth grievances (e.g., logs date grievance filed, nature
of complaint, parties involved, outcome, etc.); assists DD in defining &
developing agency strategies regarding the Youth Advocate Program (e.g.,
benchmarks other State’s juvenile correctional facilities, researches
current trends related to the detention of youth, etc.); address inquires
from the public regarding the Youth Advocate Program; act on behalf of
& for the DD in his/her absence for reasons pertaining to the maintenance,
function, or existence of the Youth Advocate Program; requires extensive
travel which may involve overnight stays.
30% — Provides training to incarcerated youth and DYS employees for
the Youth Advocate Program (e.g., eligibility, time limits and other related
laws, policies and procedures, etc.); ensures proper form development and
maintenance and accessibility by all DYS sites; utilize a personal
computer; researches, creates, maintains, and provides initial and ongoing
training for all DYS staff and youth.
10% — Speak on behalf of the Director & for the Chief of Staff at
interdepartmental meetings &/or committees addressing the rights of
incarcerated youths; act on behalf of Director & give technical advice to
the Chief of Staff for special projects/emergency responses.
Mr. Reyna has been a police officer and previously served as a Deputy Warden at
two Ohio prisons. I found him to be a warm, genuinely concerned individual but placed
in a position that is almost hopeless.


I asked about supportive staff and Mr. Reyna indicated for staff, he has a “car and
a cubicle.” He does consider the facility grievance coordinators as part of “his staff” but
I took that to be, at best, a metaphor.
What then, does the Youth Advocate actually do? He is in the field four days a
week, trying to be at each facility twice each month. The week before we spoke, Mr.
Reyna indicated that forty youths at ORV wanted to see him.
Mr. Reyna lives in the Columbus area and returns home each night from a site
visit. ORV is about a 3-hour drive each way and if he works an 8 or 9 hour day that
might give him 2 or 3 minutes with each youth if he went non-stop.
I do not believe I need to complete the thought here.
Mr. Reyna views himself, in some sense as a part of the grievance system. He
states that when he is at a facility the youth call him the grievance man. He does listen to
youth complaints about not getting their clothing back clean, “we wear rags!,” complaints
about bed linens, and the like.
He uses his knowledge of the personnel and the system to help resolve these
individual complaints. Whether he is simply a parallel track to the grievance system or
more like an independent agent attempting to solve youths’ problems is unclear to me.
Finally, Mr. Reyna also prepares Conditions of Confinement Reports for the
Director who described him to me as “my eyes and ears” in the facilities.
A copy of three of such reports are attached at Appendix F.
The concept of a youth advocate or Ombudsman is one that deserves a good deal
of support. However, with no staff and an uncertain mandate, Mr. Reyna is in an
untenable position. The first order of business should be to clarify the role and as a
barometer of the office’s significance, staff it accordingly. On April 23-23, 2006, a
conference entitled, “Opening a Closed World” was held at the LBJ School of Public
Affairs in Austin, Texas.
Speakers reviewed the various approaches taken by the Council of Europe (Sylvia
Casale), the British Prison Inspector (Anne Owers), the Swedish Ombudsman for Penal
Matters (Cecilia Nordenflt), and the California Inspector General (Matthew Cate). 58


Conference materials are in the possession of Fred Cohen.


Several themes emerged: an Ombudsman must be independent, well funded and staffed,
and able to bring about change.
The resolution of individual problems of inmates and residents is less important to
this type of office than the identification of system problems and their solution. It is the
difference between an individual lawsuit seeking damages and a broad-based, classaction, conditions lawsuit.
At the moment, the Youth Advocate’s office is largely symbolic, but worthy of
expansion along with role clarification. It could well serve as adjunctive to the individual
problem-solving of an effective grievance system in pursuit of system problems and
The Disciplinary Process
This writer has studied the various Policies and SOPs governing the DYS
disciplinary system and observed several disciplinary hearings. In Section II, I described
a disciplinary hearing involving a seriously disturbed, 15-year-old accused of creating an
“institutional hazard;” that is, cutting his arm.
He had no one to assist him, he entered a guilty plea with no explanation of the
potential consequences, and the mental health representative present (I suppose) to help
did nothing. The youth hardly was competent to challenge the charge itself based, as it
seemed, on a direct manifestation of his illness.
Based on a request from Deputy Director Monique Marrow, I outlined my
suggestions for conducting a disciplinary hearing where the youth is on the mental health
caseload or otherwise manifests evidence of a mental disorder. That outline follows:
1. No charge should be brought up at a hearing when the hearing officer previously
determines it has no basis in law or fact.
2. You do not ask the youth, "You don't want assistance, right?" Just the opposite
presumption should apply and with retarded or mentally ill youth, I would always
assign a trained representative or a youth advocate.
3. Where a youth is on the mental health caseload then the Mental Health
Assessment form used by DRC is a decent model. The initial questions relate to
hearing competency; that is, does the youth understand the charges; is he/she able


to assist an advocate; (new here) does the youth know what the potential
consequences are if found guilty?
4. You cannot assume these youth know what it means for example, to "create a
institutional hazard." The hearing officer must record the proceeding (it is not
done now) and make certain there is a record to support going forward and a
record as to competency and consequences.
5. Treatment team should carefully consider the negative consequences of any
potential disposition and, turning it around, suggest (when possible) a disposition
consistent with the treatment plan.
6. Where a youth begins to deteriorate during a hearing, the hearing officer should
suspend the hearing, stating "why" for the record and indicate when it might be
continued (e.g., when the attending psychiatrist indicates the youth is sufficiently
stable to proceed).
7. Finally, the record should reflect the extent to which the youth's illness or
condition contributed to the violation that is the subject of the hearing. This is not
to create a type of insanity defense but to put the behavior into context. The more
therapeutic the environment, the easier it will be to view harmful conduct as
"acting out" v. "willfully disobey."
I understand that this is not in policy and procedure or SOP format, but I do
suggest it is a reasonable basis for handling discipline involving a mentally disordered
In reviewing SOP, 303.01.03 (revised, Sept. 27, 2006), I found the rules to be a
bit more complicated than need be or perhaps it would be more accurate to say, verbose.
Section IV, A (7)(c) should be revisited. As with the grievance process, staff assistance
is discretionary, mandatory if the youth so requests.
I could find nothing explicit on the representative’s role except a suggestion that it
is evidence gathering. I think it is worth considering mandatory assignment of staff
assistance with the role varying depending on what the youth requires. That would
include evidence gathering, interviewing staff or youth, assisting in understanding the
charge, challenging a charge, speaking to the disposition, and the like.


Understanding the consequences of a guilty plea, in turn, would be central and I
would anticipate “plea deals” with the tribunal.
Finally, the prospect of 180 days disciplinary time added to the length of sentence
and extended terms of isolation are highly dubious sanctions.
In my judgment, extending a term of confinement, even though it is, in fact,
moving a release date, is a sanction so severe that a facility disciplinary board should not
have that authority.
Any term of “penal isolation” for more than, say, five days is constitutionally
suspect and in any settlement of this case, that issue must be clearly resolved.



Lighthouse Youth Center at Paint Creek
On October 2, 2007, Team Member Barbara Peterson paid a one-day visit to the
privately owned and operated residential center at Paint Creek, outside the village of
Bainbridge, Ohio. It was originally funded by a grant from the Office of Juvenile Justice
and Delinquency Prevention to explore the effectiveness of private sector options for a
staff-secure residential treatment of serious juvenile offenders.
Based on Ms. Peterson’s brief visit and assessment Report, Paint Creek appears to
be a success worthy of further study and evaluation. What follows is Ms. Peterson’s brief
The Lighthouse at Paint Creek is a privately owned and managed
residential rehabilitation center for males age 15-18. Maximum capacity
is 67.
The facility is located on 33 acres in Ross County. The original buildings,
it had been a sports camp, were used initially to house youth and
programs. Since 2001 two residential halls, one with 30 beds, the other
33, have been built. There are 51 single rooms and 6 that house two
In 1998 an eight-room school was constructed. The original campus had a
combination baseball diamond/football field and two tennis courts and
those remain today. The tennis courts are used for “vennis” a combination
tennis/volleyball game invented by youth. Three volleyball courts and a
track have been added. There are plans to replace the current activities
building with a full size gymnasium. Due to space limitations in the
current building the emphasis is on outdoor recreation activities in all but
the coldest weather.
The campus is open; there are no fences and no locks on the doors.
Youth, except for those in the final phases of programming, are always
within sight of a staff member. Those nearing release may spend time
doing chores off the unit but must report in at regular intervals and must


attend programming if scheduled. There has never been a successful
escape; attempted escapes average one per year for 19 years.
All staff are trained in positive interventions to de-escalate or manage
difficult situations. Over the past three years the average for use of
physical restraints is eight times per year. Since 1986 no youth or staff
member has sustained a serious injury as a result of youth to youth, youth
to staff, or the use of physical restraint.
The philosophy of LYC-PC provides the basis of all programming and
interventions. It states: “We provide interventions that promote positive
relationships and responsible lifestyles for juvenile male offenders and
their families”. The core values of programming are listed as: positive
change occurs only when there is an atmosphere of mutual respect and
personal safety; responsible thinking leads to responsible behavior and a
positive community support system enhances positive changes.
Program components include group and individual counseling sessions
with the emphasis on group activity. Each resident has a case manager
who helps him with all individual issues including family contact,
development of an individual treatment plan, and communicating progress
to referring courts and DYS.
There is a peer-mentoring program and behavior modification and reality
therapy are interwoven into all programs. The center offers chemical
dependency and sex offender services and mental health support.
Treatment never ends at LYC-PC. Even at meals staff sit at round tables
and have ‘mealtime’ conversations with youth as they all eat.
Education staff is comprised of 4 academic teachers, one career based
program teacher (CBIP) and one computer instructor. Boys are able to
earn 5 credits per year. Age and the number of high school credits earned
prior to admission make the GED a better option for most of these youth
and 74% leave the program with a GED certificate.
CBIP focuses on job finding and retention skills, consumer math and life
and social skills. Youth who are within six months of release can be


assigned to a workstation on campus. Each receives a stipend based on his
efforts at work and school. Each is eligible for an increase in stipend
every eight weeks.
Every resident has computer classes and the level of training is based on
individual competency. Certificates are available for every level of
achievement and are posted in the classroom.
In 2004 a college class of 12 qualifying students was initiated as a pilot
program. Due to the success of this trial the program continues.
There is one nurse for this facility. Medications, from individually labeled
prescription bottles, are self-administered under the supervision of a youth
worker who notes the medications as taken. Failure to take a medication
as ordered is reported to the nurse who follows up with the youth. She
sees youth individually and provides education about the medications and
the importance of taking it as prescribed. The need for the nurse to
intervene is rare. The expectation is that youth will be responsible with
medications and they are.
A dentist sees all youth every six months. Services are provided off
grounds. Youth are also seen by the dentist immediately prior to release to
complete any work and insure dental health at the time of discharge.
A family practitioner is available on grounds one day per month. His
family practice partners also provide immediate and emergency care off
site as required. Youth with a chronic disease such as asthma are seen
regularly and an interval history is provided for the physician’ visit.
Laboratory and x-ray services are provided off-site.
Immunizations are documented and completed as necessary. The nurse
provided basic health education on a number of topics including normal
growth and development and sexual development. She provides disease
related information on a 1:1 basis.
There are two youth workers per housing unit on first and second shifts
and one on the night shift. Youth participate in and are responsible for
many aspects of programming and unit management. During visits to


each housing unit youth were engaged in meaningful activities. Youth
earn jobs such as door monitor to remind others of the rules of conduct if
necessary. It was difficult to identify staff initially because they also were
involved with youth in activities. There was no yelling at any time yet
there was always conversation.
Two youth conducted my tour of the campus. They were knowledgeable
about all aspects and areas of the program and included all buildings in the
tour. One of the former dorms is used for semi-independent living
quarters for youth awaiting release and who have earned the privilege.
These youth continue in all scheduled programming and unit activities but
are permitted to sleep independently in one room of the former dorm.
There is also a cabin on grounds that has been renovated and is available
for families who are visiting. One of my guides was to be released the
following Monday and his father would be staying in the cabin overnight.
The Program Director suggested he might be able to stay with his father in
the cabin. She encouraged him to follow up by asking his unit.
The size and setting of this facility are unique in DYS as is the relationship
although the youth are not precisely the same as those in all other
facilities. The attitudes of all staff encountered were positive, youth felt
empowered prepared to sustain the changes they had made. Youth
interviewed individually and as a group had nothing but positive
comments about the experience and each also had a plan for the future.
There is much to be learned from this facility.




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